pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	mrx_tier_id	mrx_tier_type_id	mrx_tier_lbl	mrx_tier_drug_type	mrx_tier_includes	mrx_tier_spec_yn	mrx_tier_lbl_5	mrx_tier_locat	mrx_tier_inp_1m_num	mrx_tier_inp_3m_num	mrx_tier_inp_othnum	mrx_tier_inpp_1m_num	mrx_tier_inpp_3m_num	mrx_tier_inpp_othnum	mrx_tier_innpp_1m_num	mrx_tier_innpp_3m_num	mrx_tier_innpp_othnum	mrx_tier_oonp_1m_num	mrx_tier_oonp_3m_num	mrx_tier_oonp_othnumn	mrx_tier_mo_1m_num	mrx_tier_mo_3m_num	mrx_tier_mo_othnum	mrx_tier_mopp_1m_num	mrx_tier_mopp_3m_num	mrx_tier_mopp_othnum	mrx_tier_monpp_1m_num	mrx_tier_monpp_3m_num	mrx_tier_monpp_othnum	mrx_tier_lbl_4	mrx_tier_ref_price_yn	mrx_tier_cstshr_struct_type	mrx_tier_locat_coins	mrx_tier_locat_copay	mrx_tier_lbl_2	mrx_tier_inp_coins_1m	mrx_tier_inp_coins_3m	mrx_tier_inp_coins_othnum	mrx_tier_inpp_coins_1m	mrx_tier_inpp_coins_3m	mrx_tier_inpp_coins_othnum	mrx_tier_innpp_coins_1m	mrx_tier_innpp_coins_3m	mrx_tier_innpp_coins_othnum	mrx_tier_oonp_coins_1m	mrx_tier_oonp_coins_3m	mrx_tier_oonp_coins_othnum	mrx_tier_mo_coins_1m	mrx_tier_mo_coins_3m	mrx_tier_mo_coins_othnum	mrx_tier_mopp_coins_1m	mrx_tier_mopp_coins_3m	mrx_tier_mopp_coins_othnum	mrx_tier_monpp_coins_1m	mrx_tier_monpp_coins_3m	mrx_tier_monpp_coins_othnum	mrx_tier_lbl_6	mrx_tier_inp_copay_1m	mrx_tier_inp_copay_3m	mrx_tier_inp_copay_othnum	mrx_tier_inpp_copay_1m	mrx_tier_inpp_copay_3m	mrx_tier_inpp_copay_othnum	mrx_tier_innpp_copay_1m	mrx_tier_innpp_copay_3m	mrx_tier_innpp_copay_othnum	mrx_tier_oonp_copay_1m	mrx_tier_oonp_copay_3m	mrx_tier_oonp_copay_othnum	mrx_tier_mo_copay_1m	mrx_tier_mo_copay_3m	mrx_tier_mo_copay_othnum	mrx_tier_mopp_copay_1m	mrx_tier_mopp_copay_3m	mrx_tier_mopp_copay_othnum	mrx_tier_monpp_copay_1m	mrx_tier_monpp_copay_3m	mrx_tier_monpp_copay_othnum	mrx_tier_gap_cost_share	mrx_tier_benefit_type
H0104	002	0	1	04	01	H0104_002_0	3	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	15.00									3
H0104	002	0	1	04	01	H0104_002_0	3	2	1	Tier 2	000001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	90.00									3
H0104	002	0	1	04	01	H0104_002_0	3	3	1	Tier 3	000100		2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	165.00									3
H0104	002	0	1	04	01	H0104_002_0	3	4	1	Tier 4	000010		1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	2	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							3
H0104	004	0	1	04	01	H0104_004_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	15.00									4
H0104	004	0	1	04	01	H0104_004_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	2	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							4
H0104	004	0	1	04	01	H0104_004_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	165.00									4
H0104	004	0	1	04	01	H0104_004_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	90.00									4
H0104	004	0	1	04	01	H0104_004_0	3	1	3	Tier 1	010000	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	15.00								1	4
H0104	004	0	1	04	01	H0104_004_0	3	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H0104	004	0	1	04	01	H0104_004_0	3	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H0104	004	0	1	04	01	H0104_004_0	3	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H0104	007	0	1	04	01	H0104_007_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	90.00									3
H0104	007	0	1	04	01	H0104_007_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	15.00									3
H0104	007	0	1	04	01	H0104_007_0	4	3	1	Tier 3	000100		2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	165.00									3
H0104	007	0	1	04	01	H0104_007_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	2	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							3
H0104	008	0	1	04	01	H0104_008_0	3	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H0104	008	0	1	04	01	H0104_008_0	3	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H0104	008	0	1	04	01	H0104_008_0	3	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H0104	008	0	1	04	01	H0104_008_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	2	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							4
H0104	008	0	1	04	01	H0104_008_0	3	1	3	Tier 1	010000	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	15.00								1	4
H0104	008	0	1	04	01	H0104_008_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	15.00									4
H0104	008	0	1	04	01	H0104_008_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	90.00									4
H0104	008	0	1	04	01	H0104_008_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	165.00									4
H0150	001	0	1	01	01	H0150_001_0	9	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0150	001	0	1	01	01	H0150_001_0	9	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H0150	001	0	1	01	01	H0150_001_0	9	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0150	001	0	1	01	01	H0150_001_0	9	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H0150	001	0	1	01	01	H0150_001_0	9	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H0150	001	0	1	01	01	H0150_001_0	9	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H0150	001	0	1	01	01	H0150_001_0	9	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H0150	001	0	1	01	01	H0150_001_0	9	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H0150	006	0	1	01	01	H0150_006_0	5	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0150	006	0	1	01	01	H0150_006_0	5	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H0150	006	0	1	01	01	H0150_006_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H0150	006	0	1	01	01	H0150_006_0	5	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H0150	006	0	1	01	01	H0150_006_0	5	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H0150	006	0	1	01	01	H0150_006_0	5	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H0150	006	0	1	01	01	H0150_006_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0150	006	0	1	01	01	H0150_006_0	5	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H0150	015	0	1	01	01	H0150_015_0	7	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0150	015	0	1	01	01	H0150_015_0	7	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H0150	015	0	1	01	01	H0150_015_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H0150	015	0	1	01	01	H0150_015_0	7	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H0150	015	0	1	01	01	H0150_015_0	7	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H0150	015	0	1	01	01	H0150_015_0	7	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H0150	015	0	1	01	01	H0150_015_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0150	015	0	1	01	01	H0150_015_0	7	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H0151	001	0	1	01	01	H0151_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0151	001	0	1	01	01	H0151_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H0151	001	0	1	01	01	H0151_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0151	001	0	1	01	01	H0151_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H0151	013	0	1	01	01	H0151_013_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H0151	013	0	1	01	01	H0151_013_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0151	013	0	1	01	01	H0151_013_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0151	013	0	1	01	01	H0151_013_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H0151	015	0	1	01	01	H0151_015_0	6	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H0151	015	0	1	01	01	H0151_015_0	6	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H0151	015	0	1	01	01	H0151_015_0	6	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H0151	015	0	1	01	01	H0151_015_0	6	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	34.00	102.00								34.00							92.00			102.00			3
H0151	017	0	1	01	01	H0151_017_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0151	017	0	1	01	01	H0151_017_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0151	017	0	1	01	01	H0151_017_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0151	017	0	1	01	01	H0151_017_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0151	023	0	1	01	01	H0151_023_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H0151	023	0	1	01	01	H0151_023_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0151	023	0	1	01	01	H0151_023_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0151	023	0	1	01	01	H0151_023_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H0154	001	0	1	01	01	H0154_001_0	4	4	1	Tier 4	010010		1	Tier 4	010000000010000000000	31									31												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							2
H0154	001	0	1	01	01	H0154_001_0	4	3	1	Tier 3	100000		2	Tier 3	011000000010001000000	31	90								31				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	43.00	129.00								43.00				129.00									2
H0154	001	0	1	01	01	H0154_001_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010001000000	31	90								31				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	18.00	54.00								18.00				54.00									2
H0154	001	0	1	01	01	H0154_001_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	31	90								31				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				15.00									2
H0154	009	0	1	01	01	H0154_009_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	31	90								31				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				15.00									2
H0154	009	0	1	01	01	H0154_009_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010001000000	31	90								31				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	18.00	54.00								18.00				54.00									2
H0154	009	0	1	01	01	H0154_009_0	3	3	1	Tier 3	100000		2	Tier 3	011000000010001000000	31	90								31				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	43.00	129.00								43.00				129.00									2
H0154	009	0	1	01	01	H0154_009_0	3	4	1	Tier 4	010010		1	Tier 4	010000000010000000000	31									31												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							2
H0302	001	0	1	01	01	H0302_001_0	15	5	3	Tier 5	011011	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
H0302	001	0	1	01	01	H0302_001_0	15	4	3	Tier 4	100000	3	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H0302	001	0	1	01	01	H0302_001_0	15	3	3	Tier 3	000001	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H0302	001	0	1	01	01	H0302_001_0	15	2	3	Tier 2	011000	3	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	1	2		011000000010001000000	Tier 2																						Tier 2	7.00	21.00								7.00				14.00								1	4
H0302	001	0	1	01	01	H0302_001_0	15	2	1	Tier 2	011000	3	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	1	2		011000000010001000000	Tier 2																						Tier 2	7.00	21.00								7.00				14.00									4
H0302	001	0	1	01	01	H0302_001_0	15	5	1	Tier 5	011011	1	1	Tier 5	011000000010001000000	30	90								30				90								Tier 5	1	1	011000000010001000000		Tier 5	20	20								20				20								Tier 5																							4
H0302	001	0	1	01	01	H0302_001_0	15	4	1	Tier 4	100000	3	2	Tier 4	011000000010001000000	30	90								30				90								Tier 4	1	2		011000000010001000000	Tier 4																						Tier 4	50.00	150.00								50.00				100.00									4
H0302	001	0	1	01	01	H0302_001_0	15	1	1	Tier 1	001000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	1	2		011000000010001000000	Tier 1																						Tier 1	0.00	0.00								0.00				0.00									4
H0302	001	0	1	01	01	H0302_001_0	15	3	1	Tier 3	000001	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	1	2		011000000010001000000	Tier 3																						Tier 3	25.00	75.00								25.00				50.00									4
H0302	001	0	1	01	01	H0302_001_0	15	1	3	Tier 1	001000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	1	2		011000000010001000000	Tier 1																						Tier 1	0.00	0.00								0.00				0.00								1	4
H0302	004	0	1	01	01	H0302_004_0	14	5	3	Tier 5	011011	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
H0302	004	0	1	01	01	H0302_004_0	14	4	3	Tier 4	100000	3	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H0302	004	0	1	01	01	H0302_004_0	14	3	3	Tier 3	000001	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H0302	004	0	1	01	01	H0302_004_0	14	2	3	Tier 2	011000	3	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	1	2		011000000010001000000	Tier 2																						Tier 2	7.00	21.00								7.00				14.00								1	4
H0302	004	0	1	01	01	H0302_004_0	14	1	3	Tier 1	001000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	1	2		011000000010001000000	Tier 1																						Tier 1	0.00	0.00								0.00				0.00								1	4
H0302	004	0	1	01	01	H0302_004_0	14	5	1	Tier 5	011011	1	1	Tier 5	011000000010001000000	30	90								30				90								Tier 5	1	1	011000000010001000000		Tier 5	20	20								20				20								Tier 5																							4
H0302	004	0	1	01	01	H0302_004_0	14	4	1	Tier 4	100000	3	2	Tier 4	011000000010001000000	30	90								30				90								Tier 4	1	2		011000000010001000000	Tier 4																						Tier 4	50.00	150.00								50.00				100.00									4
H0302	004	0	1	01	01	H0302_004_0	14	2	1	Tier 2	011000	3	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	1	2		011000000010001000000	Tier 2																						Tier 2	7.00	21.00								7.00				14.00									4
H0302	004	0	1	01	01	H0302_004_0	14	1	1	Tier 1	001000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	1	2		011000000010001000000	Tier 1																						Tier 1	0.00	0.00								0.00				0.00									4
H0302	004	0	1	01	01	H0302_004_0	14	3	1	Tier 3	000001	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	1	2		011000000010001000000	Tier 3																						Tier 3	25.00	75.00								25.00				50.00									4
H0303	013	0	1	01	01	H0303_013_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0303	013	0	1	01	01	H0303_013_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0303	013	0	1	01	01	H0303_013_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0303	013	0	1	01	01	H0303_013_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0303	015	0	1	01	01	H0303_015_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0303	015	0	1	01	01	H0303_015_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0303	015	0	1	01	01	H0303_015_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0303	015	0	1	01	01	H0303_015_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0303	034	0	1	01	01	H0303_034_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0303	034	0	1	01	01	H0303_034_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0303	034	0	1	01	01	H0303_034_0	4	3	1	Tier 3 Non-Preferred	000010	1	2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			4
H0303	034	0	1	01	01	H0303_034_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0303	035	0	1	01	01	H0303_035_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0303	035	0	1	01	01	H0303_035_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0303	035	0	1	01	01	H0303_035_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0303	035	0	1	01	01	H0303_035_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0303	036	0	1	01	01	H0303_036_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0303	036	0	1	01	01	H0303_036_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0303	036	0	1	01	01	H0303_036_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				55.40	166.20		55.40	166.20		55.40							156.20			166.20			4
H0303	036	0	1	01	01	H0303_036_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0303	036	0	1	01	01	H0303_036_0	6	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H0303	036	0	1	01	01	H0303_036_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0303	036	0	1	01	01	H0303_036_0	6	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0303	036	0	1	01	01	H0303_036_0	6	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0303	037	0	1	01	01	H0303_037_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				56.25	168.75		56.25	168.75		56.25							158.75			168.75			4
H0303	037	0	1	01	01	H0303_037_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0303	037	0	1	01	01	H0303_037_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0303	037	0	1	01	01	H0303_037_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0303	037	0	1	01	01	H0303_037_0	6	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0303	037	0	1	01	01	H0303_037_0	6	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0303	037	0	1	01	01	H0303_037_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0303	037	0	1	01	01	H0303_037_0	6	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H0303	038	0	1	01	01	H0303_038_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0303	038	0	1	01	01	H0303_038_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0303	038	0	1	01	01	H0303_038_0	6	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0303	038	0	1	01	01	H0303_038_0	6	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0303	038	0	1	01	01	H0303_038_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0303	038	0	1	01	01	H0303_038_0	6	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H0303	038	0	1	01	01	H0303_038_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0303	038	0	1	01	01	H0303_038_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				56.20	168.60		56.20	168.60		56.20							158.60			168.60			4
H0303	039	0	1	01	01	H0303_039_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0303	039	0	1	01	01	H0303_039_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0303	039	0	1	01	01	H0303_039_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0303	039	0	1	01	01	H0303_039_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0307	008	0	1	01	01	H0307_008_0	5	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H0307	008	0	1	01	01	H0307_008_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H0307	008	0	1	01	01	H0307_008_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H0307	008	0	1	01	01	H0307_008_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H0316	002	0	1	01	01	H0316_002_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H0316	002	0	1	01	01	H0316_002_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0316	002	0	1	01	01	H0316_002_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0316	002	0	1	01	01	H0316_002_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H0316	005	0	1	01	01	H0316_005_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H0316	005	0	1	01	01	H0316_005_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H0316	005	0	1	01	01	H0316_005_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0316	005	0	1	01	01	H0316_005_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0316	012	0	1	01	01	H0316_012_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0316	012	0	1	01	01	H0316_012_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0316	012	0	1	01	01	H0316_012_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0316	012	0	1	01	01	H0316_012_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0317	001	0	1	04	01	H0317_001_0	5	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H0317	001	0	1	04	01	H0317_001_0	5	4	3	Speciality	100100	1	1	Speciality																							Speciality					Speciality																						Speciality																						2	4
H0317	001	0	1	04	01	H0317_001_0	5	3	3	Other-Non-Preferred	100100	1	2	Other-Non-Preferred																							Other-Non-Preferred					Other-Non-Preferred																						Other-Non-Preferred																						2	4
H0317	001	0	1	04	01	H0317_001_0	5	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0317	001	0	1	04	01	H0317_001_0	5	4	1	Speciality	100100	1	1	Speciality	010000000010010000000	30									30			30									Speciality	2	1	010000000010010000000		Speciality	25									25			25									Speciality																							4
H0317	001	0	1	04	01	H0317_001_0	5	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H0317	001	0	1	04	01	H0317_001_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H0317	001	0	1	04	01	H0317_001_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H0317	002	0	1	04	01	H0317_002_0	7	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H0317	002	0	1	04	01	H0317_002_0	7	3	1	Other- Non-Preferrede	100100	1	2	Other- Non-Preferrede	011000000010011000000	30	90								30			30	90								Other- Non-Preferrede	2	2		011000000010011000000	Other- Non-Preferrede																						Other- Non-Preferrede	50.00	150.00								50.00			50.00	125.00									4
H0317	002	0	1	04	01	H0317_002_0	7	3	3	Other- Non-Preferrede	100100	1	2	Other- Non-Preferrede																							Other- Non-Preferrede					Other- Non-Preferrede																						Other- Non-Preferrede																						2	4
H0317	002	0	1	04	01	H0317_002_0	7	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0317	002	0	1	04	01	H0317_002_0	7	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0317	002	0	1	04	01	H0317_002_0	7	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H0317	002	0	1	04	01	H0317_002_0	7	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H0317	002	0	1	04	01	H0317_002_0	7	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H0318	001	0	1	01	01	H0318_001_0	5	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H0318	001	0	1	01	01	H0318_001_0	5	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H0318	001	0	1	01	01	H0318_001_0	5	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H0318	002	0	1	01	01	H0318_002_0	6	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H0318	002	0	1	01	01	H0318_002_0	6	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H0318	002	0	1	01	01	H0318_002_0	6	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H0319	001	0	1	04	01	H0319_001_0	6	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H0319	001	0	1	04	01	H0319_001_0	6	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H0319	001	0	1	04	01	H0319_001_0	6	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H0319	001	0	1	04	01	H0319_001_0	6	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H0319	002	0	1	04	01	H0319_002_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0319	002	0	1	04	01	H0319_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0319	002	0	1	04	01	H0319_002_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0319	002	0	1	04	01	H0319_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0319	004	0	1	04	01	H0319_004_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0319	004	0	1	04	01	H0319_004_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0319	004	0	1	04	01	H0319_004_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0319	004	0	1	04	01	H0319_004_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0320	001	0	1	01	01	H0320_001_0	9	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H0320	001	0	1	01	01	H0320_001_0	9	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H0320	001	0	1	01	01	H0320_001_0	9	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H0320	001	0	1	01	01	H0320_001_0	9	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H0320	001	0	1	01	01	H0320_001_0	9	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H0320	001	0	1	01	01	H0320_001_0	9	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H0320	001	0	1	01	01	H0320_001_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H0320	001	0	1	01	01	H0320_001_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H0320	002	0	1	01	01	H0320_002_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H0320	002	0	1	01	01	H0320_002_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H0320	002	0	1	01	01	H0320_002_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H0320	002	0	1	01	01	H0320_002_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H0320	002	0	1	01	01	H0320_002_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H0320	002	0	1	01	01	H0320_002_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H0320	002	0	1	01	01	H0320_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H0320	002	0	1	01	01	H0320_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H0322	001	0	1	04	01	H0322_001_0	6	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H0322	001	0	1	04	01	H0322_001_0	6	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H0322	001	0	1	04	01	H0322_001_0	6	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H0322	002	0	1	04	01	H0322_002_0	5	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H0322	002	0	1	04	01	H0322_002_0	5	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H0322	002	0	1	04	01	H0322_002_0	5	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H0322	006	0	1	04	01	H0322_006_0	7	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
H0322	006	0	1	04	01	H0322_006_0	7	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
H0322	006	0	1	04	01	H0322_006_0	7	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0322	006	0	1	04	01	H0322_006_0	7	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0351	014	0	1	01	01	H0351_014_0	6	1	1	Tier 1	001000	1	2	Tier 1	011011011010001000000	30	90		30	90		30	90		30				90								Tier 1	1	2		011011011010001000000	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00									4
H0351	014	0	1	01	01	H0351_014_0	6	2	1	Tier 2	000001	1	2	Tier 2	011011011010001000000	30	90		30	90		30	90		30				90								Tier 2	1	2		011011011010001000000	Tier 2																						Tier 2	39.00	117.00		39.00	117.00		39.00	117.00		39.00				78.00									4
H0351	014	0	1	01	01	H0351_014_0	6	3	1	Tier 3	100100	1	2	Tier 3	011011011010001000000	30	90		30	90		30	90		30				90								Tier 3	1	2		011011011010001000000	Tier 3																						Tier 3	78.00	234.00		78.00	234.00		78.00	234.00		78.00				195.00									4
H0351	014	0	1	01	01	H0351_014_0	6	4	1	Tier 4 Injectables	010010	1	1	Tier 4 Injectables	011011011010000000000	30	90		30	90		30	90		30												Tier 4 Injectables	1	1	011011011010000000000		Tier 4 Injectables	33	33		33	33		33	33		33												Tier 4 Injectables																							4
H0351	014	0	1	01	01	H0351_014_0	6	5	1	Tier 5 Specialty	010010	1	1	Tier 5 Specialty	011011011010000000000	30	90		30	90		30	90		30												Tier 5 Specialty	1	1	011011011010000000000		Tier 5 Specialty	33	33		33	33		33	33		33												Tier 5 Specialty																							4
H0351	029	0	1	01	01	H0351_029_0	6	1	1	Tier 1	001000		2	Tier 1	011011011010001000000	30	90		30	90		30	90		30				90								Tier 1	1	2		011011011010001000000	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00									3
H0351	029	0	1	01	01	H0351_029_0	6	2	1	Tier 2	000001		2	Tier 2	011011011010001000000	30	90		30	90		30	90		30				90								Tier 2	1	2		011011011010001000000	Tier 2																						Tier 2	27.00	81.00		27.00	81.00		27.00	81.00		27.00				54.00									3
H0351	029	0	1	01	01	H0351_029_0	6	3	1	Tier 3	100100		2	Tier 3	011011011010001000000	30	90		30	90		30	90		30				90								Tier 3	1	2		011011011010001000000	Tier 3																						Tier 3	57.00	171.00		57.00	171.00		57.00	171.00		57.00				143.00									3
H0351	029	0	1	01	01	H0351_029_0	6	4	1	Tier 4 Injectables	010010		1	Tier 4 Injectables	011011011010000000000	30	90		30	90		30	90		30												Tier 4 Injectables	1	1	011011011010000000000		Tier 4 Injectables	25	25		25	25		25	25		25												Tier 4 Injectables																							3
H0351	029	0	1	01	01	H0351_029_0	6	5	1	Tier 5 Specialty	010010		1	Tier 5 Specialty	011011011010000000000	30	90		30	90		30	90		30												Tier 5 Specialty	1	1	011011011010000000000		Tier 5 Specialty	25	25		25	25		25	25		25												Tier 5 Specialty																							3
H0351	032	0	1	01	01	H0351_032_0	6	1	1	Tier 1	001000	1	2	Tier 1	011011011010001000000	30	90		30	90		30	90		30				90								Tier 1	1	2		011011011010001000000	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00									4
H0351	032	0	1	01	01	H0351_032_0	6	2	1	Tier 2	000001	1	2	Tier 2	011011011010001000000	30	90		30	90		30	90		30				90								Tier 2	1	2		011011011010001000000	Tier 2																						Tier 2	39.00	117.00		39.00	117.00		39.00	117.00		39.00				78.00									4
H0351	032	0	1	01	01	H0351_032_0	6	5	1	Tier 5 Specialty	010010	1	1	Tier 5 Specialty	011011011010000000000	30	90		30	90		30	90		30												Tier 5 Specialty	1	1	011011011010000000000		Tier 5 Specialty	33	33		33	33		33	33		33												Tier 5 Specialty																							4
H0351	032	0	1	01	01	H0351_032_0	6	4	1	Tier 4 Injectables	010010	1	1	Tier 4 Injectables	011011011010000000000	30	90		30	90		30	90		30												Tier 4 Injectables	1	1	011011011010000000000		Tier 4 Injectables	33	33		33	33		33	33		33												Tier 4 Injectables																							4
H0351	032	0	1	01	01	H0351_032_0	6	3	1	Tier 3	100100	1	2	Tier 3	011011011010001000000	30	90		30	90		30	90		30				90								Tier 3	1	2		011011011010001000000	Tier 3																						Tier 3	78.00	234.00		78.00	234.00		78.00	234.00		78.00				195.00									4
H0354	001	0	1	01	01	H0354_001_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	5.00	15.00								5.00			5.00	15.00									4
H0354	001	0	1	01	01	H0354_001_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010011000000	30	90								30			30	90								Tier 2	2	2		011000000010011000000	Tier 2																						Tier 2	25.00	75.00								25.00			25.00	75.00									4
H0354	001	0	1	01	01	H0354_001_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010011000000	30	90								30			30	90								Tier 3	2	2		011000000010011000000	Tier 3																						Tier 3	45.00	135.00								45.00			45.00	135.00									4
H0354	001	0	1	01	01	H0354_001_0	6	4	1	Tier 4	100100	1	1	Tier 4	011000000010011000000	30	90								30			30	90								Tier 4	2	2		011000000010011000000	Tier 4																						Tier 4	45.00	135.00								45.00			45.00	135.00									4
H0354	001	0	1	01	01	H0354_001_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H0354	001	0	1	01	01	H0354_001_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H0354	001	0	1	01	01	H0354_001_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	5.00	15.00								5.00			5.00	15.00								1	4
H0354	001	0	1	01	01	H0354_001_0	6	4	3	Tier 4	100100	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H0401	002	0	1	02	01	H0401_002_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H0401	002	0	1	02	01	H0401_002_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0401	002	0	1	02	01	H0401_002_0	9	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H0401	002	0	1	02	01	H0401_002_0	9	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0401	004	0	1	02	01	H0401_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0401	004	0	1	02	01	H0401_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0401	004	0	1	02	01	H0401_004_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0401	004	0	1	02	01	H0401_004_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0408	001	0	1	02	01	H0408_001_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0408	001	0	1	02	01	H0408_001_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0408	001	0	1	02	01	H0408_001_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0408	001	0	1	02	01	H0408_001_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0408	002	0	1	02	01	H0408_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0408	002	0	1	02	01	H0408_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0408	002	0	1	02	01	H0408_002_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0408	002	0	1	02	01	H0408_002_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0410	001	0	1	37	05	H0410_001_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0410	001	0	1	37	05	H0410_001_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H0410	001	0	1	37	05	H0410_001_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H0410	001	0	1	37	05	H0410_001_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H0410	003	0	1	37	05	H0410_003_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0410	003	0	1	37	05	H0410_003_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H0410	003	0	1	37	05	H0410_003_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H0410	003	0	1	37	05	H0410_003_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H0410	004	0	1	37	05	H0410_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H0410	004	0	1	37	05	H0410_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H0410	004	0	1	37	05	H0410_004_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0410	004	0	1	37	05	H0410_004_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H0504	015	0	1	01	01	H0504_015_0	4	4	1	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																							4
H0504	015	0	1	01	01	H0504_015_0	4	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				45.00	90.00		45.00	135.00		45.00				90.00									4
H0504	015	0	1	01	01	H0504_015_0	4	2	1	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				25.00	50.00		25.00	75.00		25.00				50.00									4
H0504	015	0	1	01	01	H0504_015_0	4	1	1	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				6.00	12.00		6.00	18.00		6.00				12.00									4
H0504	015	0	1	01	01	H0504_015_0	4	5	3	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																						1	4
H0504	015	0	1	01	01	H0504_015_0	4	1	3	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				6.00	12.00		6.00	18.00		6.00				12.00								1	4
H0504	015	0	1	01	01	H0504_015_0	4	2	3	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				25.00	50.00		25.00	75.00		25.00				50.00								1	4
H0504	015	0	1	01	01	H0504_015_0	4	3	3	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				45.00	90.00		45.00	135.00		45.00				90.00								1	4
H0504	015	0	1	01	01	H0504_015_0	4	4	3	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																						1	4
H0504	015	0	1	01	01	H0504_015_0	4	5	1	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																							4
H0504	017	0	1	01	01	H0504_017_0	5	4	1	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																							4
H0504	017	0	1	01	01	H0504_017_0	5	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				45.00	90.00		45.00	135.00		45.00				90.00									4
H0504	017	0	1	01	01	H0504_017_0	5	2	1	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				25.00	50.00		25.00	75.00		25.00				50.00									4
H0504	017	0	1	01	01	H0504_017_0	5	1	1	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				8.50	17.00		8.50	25.50		8.50				17.00									4
H0504	017	0	1	01	01	H0504_017_0	5	5	1	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																							4
H0504	017	0	1	01	01	H0504_017_0	5	5	3	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)																							Formulary Specialty (Unique High Cost Drugs)					Formulary Specialty (Unique High Cost Drugs)																						Formulary Specialty (Unique High Cost Drugs)																						2	4
H0504	017	0	1	01	01	H0504_017_0	5	4	3	Injectables	001001	3	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
H0504	017	0	1	01	01	H0504_017_0	5	3	3	Non-Preferred Brand	100000	3	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0504	017	0	1	01	01	H0504_017_0	5	2	3	Formulary Brand	000001	3	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H0504	017	0	1	01	01	H0504_017_0	5	1	3	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				8.50	17.00		8.50	25.50		8.50				17.00								1	4
H0504	019	0	2	01	01	H0504_019_0	4	1	1	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				6.00	12.00		6.00	18.00		6.00				12.00									4
H0504	019	0	2	01	01	H0504_019_0	4	2	1	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				25.00	50.00		25.00	75.00		25.00				50.00									4
H0504	019	0	2	01	01	H0504_019_0	4	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				45.00	90.00		45.00	135.00		45.00				90.00									4
H0504	019	0	2	01	01	H0504_019_0	4	4	1	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																							4
H0504	019	0	2	01	01	H0504_019_0	4	5	3	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																						1	4
H0504	019	0	2	01	01	H0504_019_0	4	3	3	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				45.00	90.00		45.00	135.00		45.00				90.00								1	4
H0504	019	0	2	01	01	H0504_019_0	4	2	3	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				25.00	50.00		25.00	75.00		25.00				50.00								1	4
H0504	019	0	2	01	01	H0504_019_0	4	1	3	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				6.00	12.00		6.00	18.00		6.00				12.00								1	4
H0504	019	0	2	01	01	H0504_019_0	4	5	1	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																							4
H0504	019	0	2	01	01	H0504_019_0	4	4	3	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																						1	4
H0504	021	0	1	01	01	H0504_021_0	4	1	1	Formulary Insulin & Other Program Managed Drugs	001001	3	2	Formulary Insulin & Other Program Managed Drugs	000011011010001000000				30	90		30	90		30				90								Formulary Insulin & Other Program Managed Drugs	2	2		000011011010001000000	Formulary Insulin & Other Program Managed Drugs																						Formulary Insulin & Other Program Managed Drugs				0.00	0.00		0.00	0.00		0.00				0.00									4
H0504	021	0	1	01	01	H0504_021_0	4	2	1	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				3.50	7.00		3.50	10.50		3.50				7.00									4
H0504	021	0	1	01	01	H0504_021_0	4	6	3	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																						1	4
H0504	021	0	1	01	01	H0504_021_0	4	5	3	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																						1	4
H0504	021	0	1	01	01	H0504_021_0	4	4	3	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	100.00		50.00	150.00		50.00				100.00								1	4
H0504	021	0	1	01	01	H0504_021_0	4	3	3	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				20.00	40.00		20.00	60.00		20.00				40.00								1	4
H0504	021	0	1	01	01	H0504_021_0	4	2	3	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				3.50	7.00		3.50	10.50		3.50				7.00								1	4
H0504	021	0	1	01	01	H0504_021_0	4	1	3	Formulary Insulin & Other Program Managed Drugs	001001	3	2	Formulary Insulin & Other Program Managed Drugs	000011011010001000000				30	90		30	90		30				90								Formulary Insulin & Other Program Managed Drugs	2	2		000011011010001000000	Formulary Insulin & Other Program Managed Drugs																						Formulary Insulin & Other Program Managed Drugs				0.00	0.00		0.00	0.00		0.00				0.00								1	4
H0504	021	0	1	01	01	H0504_021_0	4	6	1	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																							4
H0504	021	0	1	01	01	H0504_021_0	4	5	1	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																							4
H0504	021	0	1	01	01	H0504_021_0	4	4	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	100.00		50.00	150.00		50.00				100.00									4
H0504	021	0	1	01	01	H0504_021_0	4	3	1	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				20.00	40.00		20.00	60.00		20.00				40.00									4
H0504	023	0	2	01	01	H0504_023_0	4	1	1	Formulary Insulin & Other Program Managed Drugs	001001	3	2	Formulary Insulin & Other Program Managed Drugs	000011011010001000000				30	90		30	90		30				90								Formulary Insulin & Other Program Managed Drugs	2	2		000011011010001000000	Formulary Insulin & Other Program Managed Drugs																						Formulary Insulin & Other Program Managed Drugs				0.00	0.00		0.00	0.00		0.00				0.00									4
H0504	023	0	2	01	01	H0504_023_0	4	2	1	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				3.50	7.00		3.50	10.50		3.50				7.00									4
H0504	023	0	2	01	01	H0504_023_0	4	6	3	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																						1	4
H0504	023	0	2	01	01	H0504_023_0	4	5	3	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																						1	4
H0504	023	0	2	01	01	H0504_023_0	4	4	3	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	100.00		50.00	150.00		50.00				100.00								1	4
H0504	023	0	2	01	01	H0504_023_0	4	3	3	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				20.00	40.00		20.00	60.00		20.00				40.00								1	4
H0504	023	0	2	01	01	H0504_023_0	4	2	3	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				3.50	7.00		3.50	10.50		3.50				7.00								1	4
H0504	023	0	2	01	01	H0504_023_0	4	1	3	Formulary Insulin & Other Program Managed Drugs	001001	3	2	Formulary Insulin & Other Program Managed Drugs	000011011010001000000				30	90		30	90		30				90								Formulary Insulin & Other Program Managed Drugs	2	2		000011011010001000000	Formulary Insulin & Other Program Managed Drugs																						Formulary Insulin & Other Program Managed Drugs				0.00	0.00		0.00	0.00		0.00				0.00								1	4
H0504	023	0	2	01	01	H0504_023_0	4	6	1	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																							4
H0504	023	0	2	01	01	H0504_023_0	4	5	1	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																							4
H0504	023	0	2	01	01	H0504_023_0	4	4	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	100.00		50.00	150.00		50.00				100.00									4
H0504	023	0	2	01	01	H0504_023_0	4	3	1	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				20.00	40.00		20.00	60.00		20.00				40.00									4
H0504	025	0	1	01	01	H0504_025_0	4	1	1	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				7.00	14.00		7.00	21.00		7.00				14.00									4
H0504	025	0	1	01	01	H0504_025_0	4	2	1	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				30.00	60.00		30.00	90.00		30.00				60.00									4
H0504	025	0	1	01	01	H0504_025_0	4	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				55.00	110.00		55.00	165.00		55.00				110.00									4
H0504	025	0	1	01	01	H0504_025_0	4	4	1	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																							4
H0504	025	0	1	01	01	H0504_025_0	4	5	3	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)																							Formulary Specialty (Unique High Cost Drugs)					Formulary Specialty (Unique High Cost Drugs)																						Formulary Specialty (Unique High Cost Drugs)																						2	4
H0504	025	0	1	01	01	H0504_025_0	4	1	3	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				7.00	14.00		7.00	21.00		7.00				14.00								1	4
H0504	025	0	1	01	01	H0504_025_0	4	2	3	Formulary Brand	000001	3	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H0504	025	0	1	01	01	H0504_025_0	4	3	3	Non-Preferred Brand	100000	3	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0504	025	0	1	01	01	H0504_025_0	4	4	3	Injectables	001001	3	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
H0504	025	0	1	01	01	H0504_025_0	4	5	1	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																							4
H0523	002	0	1	01	01	H0523_002_0	5	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	002	0	1	01	01	H0523_002_0	5	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
H0523	002	0	1	01	01	H0523_002_0	5	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
H0523	002	0	1	01	01	H0523_002_0	5	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	022	0	1	01	01	H0523_022_0	5	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
H0523	022	0	1	01	01	H0523_022_0	5	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
H0523	022	0	1	01	01	H0523_022_0	5	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	022	0	1	01	01	H0523_022_0	5	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	025	0	1	01	01	H0523_025_0	5	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	025	0	1	01	01	H0523_025_0	5	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
H0523	025	0	1	01	01	H0523_025_0	5	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	025	0	1	01	01	H0523_025_0	5	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
H0523	026	0	1	01	01	H0523_026_0	5	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	026	0	1	01	01	H0523_026_0	5	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	026	0	1	01	01	H0523_026_0	5	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
H0523	026	0	1	01	01	H0523_026_0	5	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
H0523	031	0	1	01	01	H0523_031_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H0523	031	0	1	01	01	H0523_031_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H0523	031	0	1	01	01	H0523_031_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H0523	032	0	1	01	01	H0523_032_0	3	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H0523	032	0	1	01	01	H0523_032_0	3	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H0523	032	0	1	01	01	H0523_032_0	3	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H0523	034	0	1	01	01	H0523_034_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	034	0	1	01	01	H0523_034_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H0523	034	0	1	01	01	H0523_034_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0523	034	0	1	01	01	H0523_034_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H0523	034	0	1	01	01	H0523_034_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
H0523	034	0	1	01	01	H0523_034_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
H0523	034	0	1	01	01	H0523_034_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	034	0	1	01	01	H0523_034_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0523	045	0	1	01	01	H0523_045_0	3	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H0523	045	0	1	01	01	H0523_045_0	3	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H0523	045	0	1	01	01	H0523_045_0	3	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H0523	046	0	1	01	01	H0523_046_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H0523	046	0	1	01	01	H0523_046_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0523	046	0	1	01	01	H0523_046_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0523	046	0	1	01	01	H0523_046_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H0523	046	0	1	01	01	H0523_046_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	046	0	1	01	01	H0523_046_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
H0523	046	0	1	01	01	H0523_046_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
H0523	046	0	1	01	01	H0523_046_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	047	0	1	01	01	H0523_047_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H0523	047	0	1	01	01	H0523_047_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0523	047	0	1	01	01	H0523_047_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	047	0	1	01	01	H0523_047_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
H0523	047	0	1	01	01	H0523_047_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
H0523	047	0	1	01	01	H0523_047_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	047	0	1	01	01	H0523_047_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H0523	047	0	1	01	01	H0523_047_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0523	048	0	1	01	01	H0523_048_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	048	0	1	01	01	H0523_048_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0523	048	0	1	01	01	H0523_048_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0523	048	0	1	01	01	H0523_048_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H0523	048	0	1	01	01	H0523_048_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	048	0	1	01	01	H0523_048_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
H0523	048	0	1	01	01	H0523_048_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
H0523	048	0	1	01	01	H0523_048_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H0523	049	0	1	01	01	H0523_049_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H0523	049	0	1	01	01	H0523_049_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	049	0	1	01	01	H0523_049_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
H0523	049	0	1	01	01	H0523_049_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
H0523	049	0	1	01	01	H0523_049_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	049	0	1	01	01	H0523_049_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H0523	049	0	1	01	01	H0523_049_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0523	049	0	1	01	01	H0523_049_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0523	050	0	1	01	01	H0523_050_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H0523	050	0	1	01	01	H0523_050_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	050	0	1	01	01	H0523_050_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
H0523	050	0	1	01	01	H0523_050_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
H0523	050	0	1	01	01	H0523_050_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	050	0	1	01	01	H0523_050_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0523	050	0	1	01	01	H0523_050_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0523	050	0	1	01	01	H0523_050_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H0523	051	0	1	01	01	H0523_051_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H0523	051	0	1	01	01	H0523_051_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H0523	051	0	1	01	01	H0523_051_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
H0523	051	0	1	01	01	H0523_051_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
H0523	051	0	1	01	01	H0523_051_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H0523	051	0	1	01	01	H0523_051_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0523	051	0	1	01	01	H0523_051_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H0523	051	0	1	01	01	H0523_051_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0524	002	0	2	01	01	H0524_002_0	12	1	1	Generic	010000		2	Generic	010100000010010100000	30		100							30			30		100							Generic	2	2		010100000010010100000	Generic																						Generic	11.00		33.00							11.00			11.00		22.00								3
H0524	002	0	2	01	01	H0524_002_0	12	2	1	Brand-Name Drugs	000010		2	Brand-Name Drugs	010100000010010100000	30		100							30			30		100							Brand-Name Drugs	2	2		010100000010010100000	Brand-Name Drugs																						Brand-Name Drugs	40.00		120.00							40.00			40.00		80.00								3
H0524	003	0	1	01	01	H0524_003_0	5	1	1	Generic	010000		2	Generic	010100000010010100000	30		100							30			30		100							Generic	2	2		010100000010010100000	Generic																						Generic	11.00		33.00							11.00			11.00		22.00								3
H0524	003	0	1	01	01	H0524_003_0	5	2	1	Brand-Name Drugs	000010		2	Brand-Name Drugs	010100000010010100000	30		100							30			30		100							Brand-Name Drugs	2	2		010100000010010100000	Brand-Name Drugs																						Brand-Name Drugs	40.00		120.00							40.00			40.00		80.00								3
H0524	008	0	1	01	01	H0524_008_0	5	1	1	Generic	010000		2	Generic	010100000010010100000	30		100							30			30		100							Generic	2	2		010100000010010100000	Generic																						Generic	11.00		33.00							11.00			11.00		22.00								3
H0524	008	0	1	01	01	H0524_008_0	5	2	1	Brand-Name Drugs	000010		2	Brand-Name Drugs	010100000010010100000	30		100							30			30		100							Brand-Name Drugs	2	2		010100000010010100000	Brand-Name Drugs																						Brand-Name Drugs	40.00		120.00							40.00			40.00		80.00								3
H0524	010	0	2	01	01	H0524_010_0	7	1	1	Generic	010000		2	Generic	010100000010010100000	30		100							30			30		100							Generic	2	2		010100000010010100000	Generic																						Generic	11.00		33.00							11.00			11.00		22.00								3
H0524	010	0	2	01	01	H0524_010_0	7	2	1	Brand-Name Drugs	000010		2	Brand-Name Drugs	010100000010010100000	30		100							30			30		100							Brand-Name Drugs	2	2		010100000010010100000	Brand-Name Drugs																						Brand-Name Drugs	40.00		120.00							40.00			40.00		80.00								3
H0524	013	0	1	01	01	H0524_013_0	5	1	1	Generic	010000		2	Generic	010100000010010100000	30		100							30			30		100							Generic	2	2		010100000010010100000	Generic																						Generic	11.00		33.00							11.00			11.00		22.00								3
H0524	013	0	1	01	01	H0524_013_0	5	2	1	Brand-Name Drugs	000010		2	Brand-Name Drugs	010100000010010100000	30		100							30			30		100							Brand-Name Drugs	2	2		010100000010010100000	Brand-Name Drugs																						Brand-Name Drugs	40.00		120.00							40.00			40.00		80.00								3
H0524	015	0	1	01	01	H0524_015_0	13	1	1	Generic	010000		2	Generic	010100000010010100000	30		100							30			30		100							Generic	2	2		010100000010010100000	Generic																						Generic	11.00		33.00							11.00			11.00		22.00								3
H0524	015	0	1	01	01	H0524_015_0	13	2	1	Brand-Name Drugs	000010		2	Brand-Name Drugs	010100000010010100000	30		100							30			30		100							Brand-Name Drugs	2	2		010100000010010100000	Brand-Name Drugs																						Brand-Name Drugs	40.00		120.00							40.00			40.00		80.00								3
H0532	001	0	1	01	01	H0532_001_0	2	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000010001000000	34	90								34				90								Tier 1 Generic	1	2		011000000010001000000	Tier 1 Generic																						Tier 1 Generic	10.00	20.00								10.00				20.00									4
H0532	001	0	1	01	01	H0532_001_0	2	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000010001000000	34	90								34				90								Tier 2 Preferred Brand	1	2		011000000010001000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	37.00	74.00								37.00				74.00									4
H0532	001	0	1	01	01	H0532_001_0	2	3	1	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand	011000000010001000000	34	90								34				90								Tier 3 Non-Preferred Brand	1	2		011000000010001000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	59.00	118.00								59.00				118.00									4
H0532	001	0	1	01	01	H0532_001_0	2	4	1	Tier 4 Injectable	110001	1	1	Tier 4 Injectable	011000000010001000000	34	90								34				90								Tier 4 Injectable	1	1	011000000010001000000		Tier 4 Injectable	33	33								33				33								Tier 4 Injectable																							4
H0532	001	0	1	01	01	H0532_001_0	2	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000010001000000	34	90								34				90								Tier 1 Generic	1	2		011000000010001000000	Tier 1 Generic																						Tier 1 Generic	10.00	20.00								10.00				20.00								1	4
H0532	001	0	1	01	01	H0532_001_0	2	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H0532	001	0	1	01	01	H0532_001_0	2	4	3	Tier 4 Injectable	110001	1	1	Tier 4 Injectable																							Tier 4 Injectable					Tier 4 Injectable																						Tier 4 Injectable																						2	4
H0532	001	0	1	01	01	H0532_001_0	2	3	3	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H0532	006	0	1	01	01	H0532_006_0	8	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	010000000010000000000	34									34												Tier 1 Generic	1	2		010000000010000000000	Tier 1 Generic																						Tier 1 Generic	0.00									0.00													4
H0532	006	0	1	01	01	H0532_006_0	8	3	1	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand	010000000010000000000	34									34												Tier 3 Non-Preferred Brand	1	2		010000000010000000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	120.00									120.00													4
H0532	006	0	1	01	01	H0532_006_0	8	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	010000000010000000000	34									34												Tier 2 Preferred Brand	1	2		010000000010000000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	40.00									40.00													4
H0532	006	0	1	01	01	H0532_006_0	8	4	1	Tier 4 Injectable	110001	1	1	Tier 4 Injectable	010000000010000000000	34									34												Tier 4 Injectable	1	1	010000000010000000000		Tier 4 Injectable	33									33												Tier 4 Injectable																							4
H0540	020	0	1	09	04	H0540_020_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	020	0	1	09	04	H0540_020_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	020	0	1	09	04	H0540_020_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	020	0	1	09	04	H0540_020_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	020	0	1	09	04	H0540_020_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	021	0	1	09	04	H0540_021_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	021	0	1	09	04	H0540_021_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	021	0	1	09	04	H0540_021_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	021	0	1	09	04	H0540_021_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	021	0	1	09	04	H0540_021_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	023	0	1	09	04	H0540_023_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	023	0	1	09	04	H0540_023_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	023	0	1	09	04	H0540_023_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	023	0	1	09	04	H0540_023_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	023	0	1	09	04	H0540_023_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	024	0	1	09	04	H0540_024_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	024	0	1	09	04	H0540_024_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	024	0	1	09	04	H0540_024_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	024	0	1	09	04	H0540_024_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	024	0	1	09	04	H0540_024_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	025	0	1	09	04	H0540_025_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	025	0	1	09	04	H0540_025_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	025	0	1	09	04	H0540_025_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	025	0	1	09	04	H0540_025_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	025	0	1	09	04	H0540_025_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	028	0	1	09	04	H0540_028_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	028	0	1	09	04	H0540_028_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	028	0	1	09	04	H0540_028_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	028	0	1	09	04	H0540_028_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	028	0	1	09	04	H0540_028_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	032	0	1	09	04	H0540_032_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	032	0	1	09	04	H0540_032_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	032	0	1	09	04	H0540_032_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0540	032	0	1	09	04	H0540_032_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0540	032	0	1	09	04	H0540_032_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0540	032	0	1	09	04	H0540_032_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0540	032	0	1	09	04	H0540_032_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0540	032	0	1	09	04	H0540_032_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	032	0	1	09	04	H0540_032_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	032	0	1	09	04	H0540_032_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	033	0	1	09	04	H0540_033_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	033	0	1	09	04	H0540_033_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0540	033	0	1	09	04	H0540_033_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0540	033	0	1	09	04	H0540_033_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0540	033	0	1	09	04	H0540_033_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0540	033	0	1	09	04	H0540_033_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	033	0	1	09	04	H0540_033_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	033	0	1	09	04	H0540_033_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	033	0	1	09	04	H0540_033_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	033	0	1	09	04	H0540_033_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0540	040	0	1	09	04	H0540_040_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	040	0	1	09	04	H0540_040_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	040	0	1	09	04	H0540_040_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	040	0	1	09	04	H0540_040_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	040	0	1	09	04	H0540_040_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	048	0	1	09	04	H0540_048_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	048	0	1	09	04	H0540_048_0	8	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	048	0	1	09	04	H0540_048_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	048	0	1	09	04	H0540_048_0	8	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	048	0	1	09	04	H0540_048_0	8	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	049	0	1	09	04	H0540_049_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	049	0	1	09	04	H0540_049_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	049	0	1	09	04	H0540_049_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	049	0	1	09	04	H0540_049_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	049	0	1	09	04	H0540_049_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	056	0	1	09	04	H0540_056_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	056	0	1	09	04	H0540_056_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	056	0	1	09	04	H0540_056_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	056	0	1	09	04	H0540_056_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	056	0	1	09	04	H0540_056_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0540	056	0	1	09	04	H0540_056_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0540	056	0	1	09	04	H0540_056_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0540	056	0	1	09	04	H0540_056_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0540	056	0	1	09	04	H0540_056_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0540	056	0	1	09	04	H0540_056_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	060	0	1	09	04	H0540_060_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	060	0	1	09	04	H0540_060_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	060	0	1	09	04	H0540_060_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	060	0	1	09	04	H0540_060_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	060	0	1	09	04	H0540_060_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0540	060	0	1	09	04	H0540_060_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0540	060	0	1	09	04	H0540_060_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0540	060	0	1	09	04	H0540_060_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0540	060	0	1	09	04	H0540_060_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0540	060	0	1	09	04	H0540_060_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	064	0	1	09	04	H0540_064_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0540	064	0	1	09	04	H0540_064_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0540	064	0	1	09	04	H0540_064_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0540	064	0	1	09	04	H0540_064_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	064	0	1	09	04	H0540_064_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0540	064	0	1	09	04	H0540_064_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0540	064	0	1	09	04	H0540_064_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	064	0	1	09	04	H0540_064_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	064	0	1	09	04	H0540_064_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	064	0	1	09	04	H0540_064_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	069	0	1	09	04	H0540_069_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	069	0	1	09	04	H0540_069_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	069	0	1	09	04	H0540_069_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	069	0	1	09	04	H0540_069_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	069	0	1	09	04	H0540_069_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	070	0	1	09	04	H0540_070_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	070	0	1	09	04	H0540_070_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	070	0	1	09	04	H0540_070_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	070	0	1	09	04	H0540_070_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	070	0	1	09	04	H0540_070_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	075	0	1	09	04	H0540_075_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	075	0	1	09	04	H0540_075_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	075	0	1	09	04	H0540_075_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	075	0	1	09	04	H0540_075_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	075	0	1	09	04	H0540_075_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	075	0	1	09	04	H0540_075_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0540	075	0	1	09	04	H0540_075_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0540	075	0	1	09	04	H0540_075_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0540	075	0	1	09	04	H0540_075_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0540	075	0	1	09	04	H0540_075_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0540	076	0	1	09	04	H0540_076_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	076	0	1	09	04	H0540_076_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	076	0	1	09	04	H0540_076_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0540	076	0	1	09	04	H0540_076_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0540	076	0	1	09	04	H0540_076_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0540	076	0	1	09	04	H0540_076_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0540	076	0	1	09	04	H0540_076_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0540	076	0	1	09	04	H0540_076_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	076	0	1	09	04	H0540_076_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	076	0	1	09	04	H0540_076_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	080	0	1	09	04	H0540_080_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	080	0	1	09	04	H0540_080_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	080	0	1	09	04	H0540_080_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	080	0	1	09	04	H0540_080_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	080	0	1	09	04	H0540_080_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	081	0	1	09	04	H0540_081_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	081	0	1	09	04	H0540_081_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	081	0	1	09	04	H0540_081_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	081	0	1	09	04	H0540_081_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	081	0	1	09	04	H0540_081_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	084	0	1	09	04	H0540_084_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	084	0	1	09	04	H0540_084_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	084	0	1	09	04	H0540_084_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	084	0	1	09	04	H0540_084_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0540	084	0	1	09	04	H0540_084_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0540	084	0	1	09	04	H0540_084_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0540	084	0	1	09	04	H0540_084_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0540	084	0	1	09	04	H0540_084_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	084	0	1	09	04	H0540_084_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	084	0	1	09	04	H0540_084_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0540	085	0	1	09	04	H0540_085_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0540	085	0	1	09	04	H0540_085_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0540	085	0	1	09	04	H0540_085_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0540	085	0	1	09	04	H0540_085_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0540	085	0	1	09	04	H0540_085_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0540	085	0	1	09	04	H0540_085_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0540	085	0	1	09	04	H0540_085_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	085	0	1	09	04	H0540_085_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	085	0	1	09	04	H0540_085_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	085	0	1	09	04	H0540_085_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	087	0	1	09	04	H0540_087_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0540	087	0	1	09	04	H0540_087_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0540	087	0	1	09	04	H0540_087_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0540	087	0	1	09	04	H0540_087_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0540	087	0	1	09	04	H0540_087_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0543	001	0	1	01	01	H0543_001_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							5.00			15.00			4
H0543	001	0	1	01	01	H0543_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	001	0	1	01	01	H0543_001_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	001	0	1	01	01	H0543_001_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	004	0	1	01	01	H0543_004_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	004	0	1	01	01	H0543_004_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	004	0	1	01	01	H0543_004_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	004	0	1	01	01	H0543_004_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	007	0	1	01	01	H0543_007_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	007	0	1	01	01	H0543_007_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	007	0	1	01	01	H0543_007_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	007	0	1	01	01	H0543_007_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	013	0	1	01	01	H0543_013_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	013	0	1	01	01	H0543_013_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	013	0	1	01	01	H0543_013_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	013	0	1	01	01	H0543_013_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	019	0	1	01	01	H0543_019_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	019	0	1	01	01	H0543_019_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	019	0	1	01	01	H0543_019_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	019	0	1	01	01	H0543_019_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	022	0	1	01	01	H0543_022_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	022	0	1	01	01	H0543_022_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	022	0	1	01	01	H0543_022_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	022	0	1	01	01	H0543_022_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	028	0	1	01	01	H0543_028_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	028	0	1	01	01	H0543_028_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	028	0	1	01	01	H0543_028_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	028	0	1	01	01	H0543_028_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	029	0	1	01	01	H0543_029_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	029	0	1	01	01	H0543_029_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	029	0	1	01	01	H0543_029_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	029	0	1	01	01	H0543_029_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	032	0	1	01	01	H0543_032_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	032	0	1	01	01	H0543_032_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	032	0	1	01	01	H0543_032_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	032	0	1	01	01	H0543_032_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	035	0	1	01	01	H0543_035_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	035	0	1	01	01	H0543_035_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	035	0	1	01	01	H0543_035_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	035	0	1	01	01	H0543_035_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	035	0	1	01	01	H0543_035_0	6	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0543	035	0	1	01	01	H0543_035_0	6	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0543	035	0	1	01	01	H0543_035_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0543	035	0	1	01	01	H0543_035_0	6	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H0543	036	0	1	01	01	H0543_036_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	036	0	1	01	01	H0543_036_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	036	0	1	01	01	H0543_036_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	036	0	1	01	01	H0543_036_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	046	0	1	01	01	H0543_046_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	046	0	1	01	01	H0543_046_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	046	0	1	01	01	H0543_046_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	046	0	1	01	01	H0543_046_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	049	0	1	01	01	H0543_049_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	049	0	1	01	01	H0543_049_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	049	0	1	01	01	H0543_049_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	049	0	1	01	01	H0543_049_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	050	0	1	01	01	H0543_050_0	7	3	1	Non Preferred	100100	1	2	Non Preferred	000011011010000001001				30	90		30	90		30							90			90		Non Preferred	2	2		000011011010000001001	Non Preferred																						Non Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	050	0	1	01	01	H0543_050_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	050	0	1	01	01	H0543_050_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	050	0	1	01	01	H0543_050_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	060	0	1	01	01	H0543_060_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	060	0	1	01	01	H0543_060_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	060	0	1	01	01	H0543_060_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	060	0	1	01	01	H0543_060_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	065	0	1	01	01	H0543_065_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							5.00			15.00			4
H0543	065	0	1	01	01	H0543_065_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	065	0	1	01	01	H0543_065_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	065	0	1	01	01	H0543_065_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	070	0	1	01	01	H0543_070_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	070	0	1	01	01	H0543_070_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	070	0	1	01	01	H0543_070_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	070	0	1	01	01	H0543_070_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	071	0	1	01	01	H0543_071_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	071	0	1	01	01	H0543_071_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	071	0	1	01	01	H0543_071_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	071	0	1	01	01	H0543_071_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	072	0	1	01	01	H0543_072_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	072	0	1	01	01	H0543_072_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	072	0	1	01	01	H0543_072_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	072	0	1	01	01	H0543_072_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	077	0	1	01	01	H0543_077_0	7	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							5.00			15.00		1	4
H0543	077	0	1	01	01	H0543_077_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00		1	4
H0543	077	0	1	01	01	H0543_077_0	7	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0543	077	0	1	01	01	H0543_077_0	7	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0543	077	0	1	01	01	H0543_077_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							5.00			15.00			4
H0543	077	0	1	01	01	H0543_077_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	077	0	1	01	01	H0543_077_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	077	0	1	01	01	H0543_077_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	078	0	1	01	01	H0543_078_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0543	078	0	1	01	01	H0543_078_0	8	3	1	Tier 3 Non-Preferred	000010	1	2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			4
H0543	078	0	1	01	01	H0543_078_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0543	078	0	1	01	01	H0543_078_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0543	079	0	1	01	01	H0543_079_0	6	3	1	Tier 3 Non-Preferred	000010	1	2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			4
H0543	079	0	1	01	01	H0543_079_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0543	079	0	1	01	01	H0543_079_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0543	079	0	1	01	01	H0543_079_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0543	081	0	1	01	01	H0543_081_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0543	081	0	1	01	01	H0543_081_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0543	081	0	1	01	01	H0543_081_0	8	3	1	Tier 3 Non-Preferred	000010	1	2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			4
H0543	081	0	1	01	01	H0543_081_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0543	082	0	1	01	01	H0543_082_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	082	0	1	01	01	H0543_082_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	082	0	1	01	01	H0543_082_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	082	0	1	01	01	H0543_082_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	083	0	1	01	01	H0543_083_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	083	0	1	01	01	H0543_083_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	083	0	1	01	01	H0543_083_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	083	0	1	01	01	H0543_083_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	083	0	1	01	01	H0543_083_0	6	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H0543	083	0	1	01	01	H0543_083_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0543	083	0	1	01	01	H0543_083_0	6	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0543	083	0	1	01	01	H0543_083_0	6	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0543	084	0	1	01	01	H0543_084_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	084	0	1	01	01	H0543_084_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	084	0	1	01	01	H0543_084_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	084	0	1	01	01	H0543_084_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	085	0	1	01	01	H0543_085_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	085	0	1	01	01	H0543_085_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	085	0	1	01	01	H0543_085_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	085	0	1	01	01	H0543_085_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	086	0	1	01	01	H0543_086_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	086	0	1	01	01	H0543_086_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	086	0	1	01	01	H0543_086_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	086	0	1	01	01	H0543_086_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	089	0	1	01	01	H0543_089_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	089	0	1	01	01	H0543_089_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	089	0	1	01	01	H0543_089_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	089	0	1	01	01	H0543_089_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	091	0	1	01	01	H0543_091_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	091	0	1	01	01	H0543_091_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	091	0	1	01	01	H0543_091_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	091	0	1	01	01	H0543_091_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	093	0	1	01	01	H0543_093_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	093	0	1	01	01	H0543_093_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	093	0	1	01	01	H0543_093_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	093	0	1	01	01	H0543_093_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	095	0	1	01	01	H0543_095_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	095	0	1	01	01	H0543_095_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	095	0	1	01	01	H0543_095_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	095	0	1	01	01	H0543_095_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	116	0	1	01	01	H0543_116_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	116	0	1	01	01	H0543_116_0	7	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0543	116	0	1	01	01	H0543_116_0	7	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0543	116	0	1	01	01	H0543_116_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0543	116	0	1	01	01	H0543_116_0	7	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H0543	116	0	1	01	01	H0543_116_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	116	0	1	01	01	H0543_116_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				58.00	174.00		58.00	174.00		58.00							164.00			174.00			4
H0543	116	0	1	01	01	H0543_116_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	118	0	1	01	01	H0543_118_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	118	0	1	01	01	H0543_118_0	7	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H0543	118	0	1	01	01	H0543_118_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0543	118	0	1	01	01	H0543_118_0	7	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0543	118	0	1	01	01	H0543_118_0	7	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0543	118	0	1	01	01	H0543_118_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	118	0	1	01	01	H0543_118_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	118	0	1	01	01	H0543_118_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				57.95	173.85		57.95	173.85		57.95							163.85			173.85			4
H0543	120	0	1	01	01	H0543_120_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0543	120	0	1	01	01	H0543_120_0	7	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0543	120	0	1	01	01	H0543_120_0	7	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0543	120	0	1	01	01	H0543_120_0	7	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H0543	120	0	1	01	01	H0543_120_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	120	0	1	01	01	H0543_120_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				57.20	171.60		57.20	171.60		57.20							161.60			171.60			4
H0543	120	0	1	01	01	H0543_120_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	120	0	1	01	01	H0543_120_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	122	0	1	01	01	H0543_122_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	122	0	1	01	01	H0543_122_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	122	0	1	01	01	H0543_122_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	122	0	1	01	01	H0543_122_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	125	0	1	01	01	H0543_125_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	125	0	1	01	01	H0543_125_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	125	0	1	01	01	H0543_125_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	125	0	1	01	01	H0543_125_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	126	0	1	01	01	H0543_126_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	126	0	1	01	01	H0543_126_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	126	0	1	01	01	H0543_126_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	126	0	1	01	01	H0543_126_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	127	0	1	01	01	H0543_127_0	5	3	1	Non Preferred	100100	1	2	Non Preferred	000011011010000001001				30	90		30	90		30							90			90		Non Preferred	2	2		000011011010000001001	Non Preferred																						Non Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	127	0	1	01	01	H0543_127_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	127	0	1	01	01	H0543_127_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	127	0	1	01	01	H0543_127_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	128	0	1	01	01	H0543_128_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	128	0	1	01	01	H0543_128_0	5	3	1	Non Preferred	100100	1	2	Non Preferred	000011011010000001001				30	90		30	90		30							90			90		Non Preferred	2	2		000011011010000001001	Non Preferred																						Non Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	128	0	1	01	01	H0543_128_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0543	128	0	1	01	01	H0543_128_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	129	0	1	01	01	H0543_129_0	8	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0543	129	0	1	01	01	H0543_129_0	8	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0543	129	0	1	01	01	H0543_129_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				45.00	135.00		45.00	135.00		45.00							125.00			135.00		1	4
H0543	129	0	1	01	01	H0543_129_0	8	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				10.00	30.00		10.00	30.00		10.00							10.00			30.00		1	4
H0543	129	0	1	01	01	H0543_129_0	8	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0543	129	0	1	01	01	H0543_129_0	8	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0543	129	0	1	01	01	H0543_129_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0543	129	0	1	01	01	H0543_129_0	8	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							5.00			15.00			4
H0543	130	0	1	01	01	H0543_130_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0543	130	0	1	01	01	H0543_130_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0543	130	0	1	01	01	H0543_130_0	8	3	1	Tier 3 Non-Preferred	000010	1	2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			4
H0543	130	0	1	01	01	H0543_130_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0543	131	0	1	01	01	H0543_131_0	5	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H0543	131	0	1	01	01	H0543_131_0	5	3	1	Tier 3 Non-Preferred	000010		2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			3
H0543	131	0	1	01	01	H0543_131_0	5	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			3
H0543	131	0	1	01	01	H0543_131_0	5	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H0544	001	0	1	01	01	H0544_001_0	9	6	1	Injectable	010010	1	2	Injectable	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Injectable	1	1	011011011011011011011		Injectable	20	20		20	20		20	20		20	20		20	20		20	20		20	20		Injectable																							4
H0544	001	0	1	01	01	H0544_001_0	9	7	1	Specialty	010010	1	1	Specialty	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Specialty	1	1	011011011011011011011		Specialty	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Specialty																							4
H0544	001	0	1	01	01	H0544_001_0	9	1	1	Preferred Generic	011000	1	2	Preferred Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Generic	2	2		011011011011011011011	Preferred Generic																						Preferred Generic	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	001	0	1	01	01	H0544_001_0	9	2	1	Generic	010100	3	2	Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Generic	2	2		011011011011011011011	Generic																						Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00		5.00	10.00		5.00	10.00		5.00	10.00			4
H0544	001	0	1	01	01	H0544_001_0	9	3	1	Program Managed	000010	1	2	Program Managed	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Program Managed	1	2		011011011011011011011	Program Managed																						Program Managed	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	001	0	1	01	01	H0544_001_0	9	4	1	Preferred Brand	000001	3	2	Preferred Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Brand	1	2		011011011011011011011	Preferred Brand																						Preferred Brand	25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00		25.00	50.00		25.00	50.00		25.00	50.00			4
H0544	001	0	1	01	01	H0544_001_0	9	5	1	Brand	100000	1	2	Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Brand	1	2		011011011011011011011	Brand																						Brand	50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00		50.00	100.00		50.00	100.00		50.00	100.00			4
H0544	002	0	1	01	01	H0544_002_0	8	4	1	Preferred Brand	000001	3	2	Preferred Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Brand	1	2		011011011011011011011	Preferred Brand																						Preferred Brand	25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00		25.00	50.00		25.00	50.00		25.00	50.00			4
H0544	002	0	1	01	01	H0544_002_0	8	3	1	Program Managed	000010	1	2	Program Managed	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Program Managed	1	2		011011011011011011011	Program Managed																						Program Managed	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	002	0	1	01	01	H0544_002_0	8	2	1	Generic	010100	3	2	Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Generic	2	2		011011011011011011011	Generic																						Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00		5.00	10.00		5.00	10.00		5.00	10.00			4
H0544	002	0	1	01	01	H0544_002_0	8	1	1	Preferred Generic	011000	1	2	Preferred Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Generic	2	2		011011011011011011011	Preferred Generic																						Preferred Generic	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	002	0	1	01	01	H0544_002_0	8	5	1	Brand	100000	1	2	Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Brand	1	2		011011011011011011011	Brand																						Brand	50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00		50.00	100.00		50.00	100.00		50.00	100.00			4
H0544	002	0	1	01	01	H0544_002_0	8	6	1	Injectable	010010	1	2	Injectable	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Injectable	1	1	011011011011011011011		Injectable	20	20		20	20		20	20		20	20		20	20		20	20		20	20		Injectable																							4
H0544	002	0	1	01	01	H0544_002_0	8	7	1	Specialty	010010	1	1	Specialty	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Specialty	1	1	011011011011011011011		Specialty	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Specialty																							4
H0544	003	0	1	01	01	H0544_003_0	10	4	1	Preferred Brand	000001	3	2	Preferred Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Brand	1	1	011011011011011011011		Preferred Brand	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Preferred Brand																							4
H0544	003	0	1	01	01	H0544_003_0	10	3	1	Program Managed	100111	3	2	Program Managed	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Program Managed	1	1	011011011011011011011		Program Managed	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Program Managed																							4
H0544	003	0	1	01	01	H0544_003_0	10	2	1	Generic	010000	3	2	Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Generic	1	2		011011011011011011011	Generic																						Generic	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	003	0	1	01	01	H0544_003_0	10	1	1	Preferred Generic	001000	3	2	Preferred Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Generic	1	2		011011011011011011011	Preferred Generic																						Preferred Generic	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	003	0	1	01	01	H0544_003_0	10	5	1	Brand	100010	3	2	Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Brand	1	1	011011011011011011011		Brand	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Brand																							4
H0544	003	0	1	01	01	H0544_003_0	10	9	1	Non-Part D Brand	000010	2	2	Non-Part D Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Non-Part D Brand	1	2		011011011011011011011	Non-Part D Brand																						Non-Part D Brand	25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00		25.00	50.00		25.00	50.00		25.00	50.00			4
H0544	003	0	1	01	01	H0544_003_0	10	8	1	Non-Part D Generic	010000	2	2	Non-Part D Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Non-Part D Generic	1	2		011011011011011011011	Non-Part D Generic																						Non-Part D Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00		5.00	10.00		5.00	10.00		5.00	10.00			4
H0544	003	0	1	01	01	H0544_003_0	10	7	1	Specialty	111111	3	1	Specialty	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Specialty	1	1	011011011011011011011		Specialty	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Specialty																							4
H0544	003	0	1	01	01	H0544_003_0	10	6	1	Injectable	111111	3	2	Injectable	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Injectable	1	1	011011011011011011011		Injectable	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Injectable																							4
H0544	004	0	1	01	01	H0544_004_0	8	1	1	Preferred Generic	011000	1	2	Preferred Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Generic	2	2		011011011011011011011	Preferred Generic																						Preferred Generic	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	004	0	1	01	01	H0544_004_0	8	2	1	Generic	010100	1	2	Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Generic	2	2		011011011011011011011	Generic																						Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00		5.00	10.00		5.00	10.00		5.00	10.00			4
H0544	004	0	1	01	01	H0544_004_0	8	6	1	Injectable	010010	1	2	Injectable	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Injectable	1	1	011011011011011011011		Injectable	20	20		20	20		20	20		20	20		20	20		20	20		20	20		Injectable																							4
H0544	004	0	1	01	01	H0544_004_0	8	5	1	Brand	100000	1	2	Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Brand	1	2		011011011011011011011	Brand																						Brand	50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00		50.00	100.00		50.00	100.00		50.00	100.00			4
H0544	004	0	1	01	01	H0544_004_0	8	4	1	Preferred Brand	000001	1	2	Preferred Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Brand	1	2		011011011011011011011	Preferred Brand																						Preferred Brand	25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00		25.00	50.00		25.00	50.00		25.00	50.00			4
H0544	004	0	1	01	01	H0544_004_0	8	3	1	Program Managed	000010	1	2	Program Managed	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Program Managed	1	2		011011011011011011011	Program Managed																						Program Managed	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	004	0	1	01	01	H0544_004_0	8	7	1	Specialty	010010	1	1	Specialty	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Specialty	1	1	011011011011011011011		Specialty	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Specialty																							4
H0544	005	0	1	01	01	H0544_005_0	8	1	1	Preferred Generic	011000	1	2	Preferred Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Generic	2	2		011011011011011011011	Preferred Generic																						Preferred Generic	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	005	0	1	01	01	H0544_005_0	8	7	1	Specialty	010010	1	1	Specialty	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Specialty	1	1	011011011011011011011		Specialty	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Specialty																							4
H0544	005	0	1	01	01	H0544_005_0	8	6	1	Injectable	010010	1	2	Injectable	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Injectable	1	1	011011011011011011011		Injectable	20	20		20	20		20	20		20	20		20	20		20	20		20	20		Injectable																							4
H0544	005	0	1	01	01	H0544_005_0	8	5	1	Brand	100000	1	2	Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Brand	1	2		011011011011011011011	Brand																						Brand	50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00		50.00	100.00		50.00	100.00		50.00	100.00			4
H0544	005	0	1	01	01	H0544_005_0	8	4	1	Preferred Brand	000001	1	2	Preferred Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Brand	1	2		011011011011011011011	Preferred Brand																						Preferred Brand	25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00		25.00	50.00		25.00	50.00		25.00	50.00			4
H0544	005	0	1	01	01	H0544_005_0	8	3	1	Program Managed	000010	1	2	Program Managed	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Program Managed	1	2		011011011011011011011	Program Managed																						Program Managed	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	005	0	1	01	01	H0544_005_0	8	2	1	Generic	010100	1	2	Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Generic	2	2		011011011011011011011	Generic																						Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00		5.00	10.00		5.00	10.00		5.00	10.00			4
H0544	007	0	1	01	01	H0544_007_0	9	2	1	Generic	010100	1	2	Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Generic	2	2		011011011011011011011	Generic																						Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00		5.00	10.00		5.00	10.00		5.00	10.00			4
H0544	007	0	1	01	01	H0544_007_0	9	1	1	Preferred Generic	011000	1	2	Preferred Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Generic	2	2		011011011011011011011	Preferred Generic																						Preferred Generic	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0544	007	0	1	01	01	H0544_007_0	9	7	1	Specialty	010010	1	1	Specialty	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Specialty	1	1	011011011011011011011		Specialty	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Specialty																							4
H0544	007	0	1	01	01	H0544_007_0	9	6	1	Injectable	010010	1	2	Injectable	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Injectable	1	1	011011011011011011011		Injectable	20	20		20	20		20	20		20	20		20	20		20	20		20	20		Injectable																							4
H0544	007	0	1	01	01	H0544_007_0	9	5	1	Brand	100000	1	2	Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Brand	1	2		011011011011011011011	Brand																						Brand	50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00		50.00	100.00		50.00	100.00		50.00	100.00			4
H0544	007	0	1	01	01	H0544_007_0	9	4	1	Preferred Brand	000001	1	2	Preferred Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Brand	1	2		011011011011011011011	Preferred Brand																						Preferred Brand	25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00		25.00	50.00		25.00	50.00		25.00	50.00			4
H0544	007	0	1	01	01	H0544_007_0	9	3	1	Program Managed	000010	1	2	Program Managed	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Program Managed	1	2		011011011011011011011	Program Managed																						Program Managed	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H0545	001	0	1	01	01	H0545_001_0	2	5	1	Specialty and High Cost	000010	1	1	Specialty and High Cost	011000000010001000000	30	90								30				90								Specialty and High Cost	2	1	011000000010001000000		Specialty and High Cost	25	25								25				25								Specialty and High Cost																							4
H0545	001	0	1	01	01	H0545_001_0	2	4	1	Miscellaneous Injectibles	010010	1	2	Miscellaneous Injectibles	011000000010001000000	30	90								30				90								Miscellaneous Injectibles	2	1	011000000010001000000		Miscellaneous Injectibles	10	10								10				10								Miscellaneous Injectibles																							4
H0545	001	0	1	01	01	H0545_001_0	2	1	3	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	10.00								5.00				10.00								1	4
H0545	001	0	1	01	01	H0545_001_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0545	001	0	1	01	01	H0545_001_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0545	001	0	1	01	01	H0545_001_0	2	4	3	Miscellaneous Injectibles	010010	1	2	Miscellaneous Injectibles																							Miscellaneous Injectibles					Miscellaneous Injectibles																						Miscellaneous Injectibles																						2	4
H0545	001	0	1	01	01	H0545_001_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	37.00	74.00								37.00				74.00									4
H0545	001	0	1	01	01	H0545_001_0	2	5	3	Specialty and High Cost	000010	1	1	Specialty and High Cost																							Specialty and High Cost					Specialty and High Cost																						Specialty and High Cost																						2	4
H0545	001	0	1	01	01	H0545_001_0	2	1	1	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	10.00								5.00				10.00									4
H0545	001	0	1	01	01	H0545_001_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	24.00	48.00								24.00				48.00									4
H0562	002	0	1	01	01	H0562_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	002	0	1	01	01	H0562_002_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	002	0	1	01	01	H0562_002_0	3	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0562	002	0	1	01	01	H0562_002_0	3	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
H0562	002	0	1	01	01	H0562_002_0	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0562	002	0	1	01	01	H0562_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0562	002	0	1	01	01	H0562_002_0	3	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00							1	4
H0562	002	0	1	01	01	H0562_002_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	002	0	1	01	01	H0562_002_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	002	0	1	01	01	H0562_002_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	009	0	1	01	01	H0562_009_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	009	0	1	01	01	H0562_009_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	009	0	1	01	01	H0562_009_0	5	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	009	0	1	01	01	H0562_009_0	5	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	009	0	1	01	01	H0562_009_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	010	0	1	01	01	H0562_010_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	010	0	1	01	01	H0562_010_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	010	0	1	01	01	H0562_010_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	010	0	1	01	01	H0562_010_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	010	0	1	01	01	H0562_010_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	011	0	1	01	01	H0562_011_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	011	0	1	01	01	H0562_011_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	011	0	1	01	01	H0562_011_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	011	0	1	01	01	H0562_011_0	6	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	011	0	1	01	01	H0562_011_0	6	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	012	0	1	01	01	H0562_012_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	012	0	1	01	01	H0562_012_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	012	0	1	01	01	H0562_012_0	3	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0562	012	0	1	01	01	H0562_012_0	3	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
H0562	012	0	1	01	01	H0562_012_0	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0562	012	0	1	01	01	H0562_012_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0562	012	0	1	01	01	H0562_012_0	3	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00							1	4
H0562	012	0	1	01	01	H0562_012_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	012	0	1	01	01	H0562_012_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	012	0	1	01	01	H0562_012_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	017	0	1	01	01	H0562_017_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	017	0	1	01	01	H0562_017_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	017	0	1	01	01	H0562_017_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	017	0	1	01	01	H0562_017_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	017	0	1	01	01	H0562_017_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	036	0	1	01	01	H0562_036_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	036	0	1	01	01	H0562_036_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	036	0	1	01	01	H0562_036_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	036	0	1	01	01	H0562_036_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	036	0	1	01	01	H0562_036_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	037	0	1	01	01	H0562_037_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	037	0	1	01	01	H0562_037_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	037	0	1	01	01	H0562_037_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	037	0	1	01	01	H0562_037_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	037	0	1	01	01	H0562_037_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	039	0	1	01	01	H0562_039_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	039	0	1	01	01	H0562_039_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	039	0	1	01	01	H0562_039_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	039	0	1	01	01	H0562_039_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	039	0	1	01	01	H0562_039_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	040	0	1	01	01	H0562_040_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	040	0	1	01	01	H0562_040_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	040	0	1	01	01	H0562_040_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	040	0	1	01	01	H0562_040_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	040	0	1	01	01	H0562_040_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	053	0	1	01	01	H0562_053_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	053	0	1	01	01	H0562_053_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	053	0	1	01	01	H0562_053_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	053	0	1	01	01	H0562_053_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	053	0	1	01	01	H0562_053_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	055	0	1	01	01	H0562_055_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
H0562	055	0	1	01	01	H0562_055_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	25.00	75.00	50.00							25.00	75.00	50.00		50.00	50.00								3
H0562	055	0	1	01	01	H0562_055_0	4	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	55.00	165.00	110.00							55.00	165.00	110.00		138.00	110.00								3
H0562	055	0	1	01	01	H0562_055_0	4	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
H0562	055	0	1	01	01	H0562_055_0	4	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
H0562	056	0	1	01	01	H0562_056_0	5	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	056	0	1	01	01	H0562_056_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	50.00	150.00	100.00							50.00	150.00	100.00		125.00	100.00								4
H0562	056	0	1	01	01	H0562_056_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	25.00	75.00	50.00							25.00	75.00	50.00		50.00	50.00								4
H0562	056	0	1	01	01	H0562_056_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	056	0	1	01	01	H0562_056_0	5	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	056	0	1	01	01	H0562_056_0	5	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0562	056	0	1	01	01	H0562_056_0	5	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
H0562	056	0	1	01	01	H0562_056_0	5	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0562	056	0	1	01	01	H0562_056_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0562	056	0	1	01	01	H0562_056_0	5	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00							1	4
H0562	058	0	1	01	01	H0562_058_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	058	0	1	01	01	H0562_058_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	058	0	1	01	01	H0562_058_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	058	0	1	01	01	H0562_058_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	058	0	1	01	01	H0562_058_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	059	0	1	01	01	H0562_059_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	059	0	1	01	01	H0562_059_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	059	0	1	01	01	H0562_059_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	059	0	1	01	01	H0562_059_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	059	0	1	01	01	H0562_059_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	060	0	1	01	01	H0562_060_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	060	0	1	01	01	H0562_060_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	060	0	1	01	01	H0562_060_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	060	0	1	01	01	H0562_060_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	060	0	1	01	01	H0562_060_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	061	0	1	01	01	H0562_061_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	061	0	1	01	01	H0562_061_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	061	0	1	01	01	H0562_061_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	061	0	1	01	01	H0562_061_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	061	0	1	01	01	H0562_061_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	062	0	1	01	01	H0562_062_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	062	0	1	01	01	H0562_062_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	062	0	1	01	01	H0562_062_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	062	0	1	01	01	H0562_062_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	062	0	1	01	01	H0562_062_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	068	0	1	01	01	H0562_068_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H0562	068	0	1	01	01	H0562_068_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0562	068	0	1	01	01	H0562_068_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H0562	068	0	1	01	01	H0562_068_0	4	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0562	068	0	1	01	01	H0562_068_0	4	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0562	070	0	1	01	01	H0562_070_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	25.00	75.00	50.00							25.00	75.00	50.00		50.00	50.00								3
H0562	070	0	1	01	01	H0562_070_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
H0562	070	0	1	01	01	H0562_070_0	4	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	55.00	165.00	110.00							55.00	165.00	110.00		138.00	110.00								3
H0562	070	0	1	01	01	H0562_070_0	4	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
H0562	070	0	1	01	01	H0562_070_0	4	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
H0564	003	0	1	01	01	H0564_003_0	6	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
H0564	003	0	1	01	01	H0564_003_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
H0564	003	0	1	01	01	H0564_003_0	6	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
H0564	003	0	1	01	01	H0564_003_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
H0564	003	0	1	01	01	H0564_003_0	6	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
H0564	004	0	1	01	01	H0564_004_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0564	004	0	1	01	01	H0564_004_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0564	004	0	1	01	01	H0564_004_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0564	004	0	1	01	01	H0564_004_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0564	004	0	1	01	01	H0564_004_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0564	004	0	1	01	01	H0564_004_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0564	004	0	1	01	01	H0564_004_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0564	004	0	1	01	01	H0564_004_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0564	004	0	1	01	01	H0564_004_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0564	004	0	1	01	01	H0564_004_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0564	005	0	1	01	01	H0564_005_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0564	005	0	1	01	01	H0564_005_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0564	005	0	1	01	01	H0564_005_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0564	005	0	1	01	01	H0564_005_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0564	005	0	1	01	01	H0564_005_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0564	005	0	1	01	01	H0564_005_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0564	005	0	1	01	01	H0564_005_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0564	005	0	1	01	01	H0564_005_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0564	005	0	1	01	01	H0564_005_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0564	005	0	1	01	01	H0564_005_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0564	006	0	1	01	01	H0564_006_0	8	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0564	006	0	1	01	01	H0564_006_0	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0564	006	0	1	01	01	H0564_006_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0564	006	0	1	01	01	H0564_006_0	8	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0564	006	0	1	01	01	H0564_006_0	8	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0564	006	0	1	01	01	H0564_006_0	8	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0564	006	0	1	01	01	H0564_006_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0564	006	0	1	01	01	H0564_006_0	8	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0564	006	0	1	01	01	H0564_006_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0564	006	0	1	01	01	H0564_006_0	8	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0564	007	0	1	01	01	H0564_007_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0564	007	0	1	01	01	H0564_007_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0564	007	0	1	01	01	H0564_007_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0564	007	0	1	01	01	H0564_007_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0564	007	0	1	01	01	H0564_007_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0564	007	0	1	01	01	H0564_007_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0564	007	0	1	01	01	H0564_007_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0564	007	0	1	01	01	H0564_007_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0564	007	0	1	01	01	H0564_007_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0564	007	0	1	01	01	H0564_007_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0564	009	0	1	01	01	H0564_009_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H0564	009	0	1	01	01	H0564_009_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H0564	009	0	1	01	01	H0564_009_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H0564	009	0	1	01	01	H0564_009_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H0564	009	0	1	01	01	H0564_009_0	5	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H0564	009	0	1	01	01	H0564_009_0	5	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H0564	009	0	1	01	01	H0564_009_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0564	009	0	1	01	01	H0564_009_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H0564	009	0	1	01	01	H0564_009_0	5	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H0564	009	0	1	01	01	H0564_009_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H0564	040	0	1	01	01	H0564_040_0	8	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
H0564	040	0	1	01	01	H0564_040_0	8	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00							80.00			120.00			3
H0564	040	0	1	01	01	H0564_040_0	8	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	40.00	120.00								40.00							80.00			120.00			3
H0564	040	0	1	01	01	H0564_040_0	8	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	0.00	0.00								0.00							0.00			0.00			3
H0564	040	0	1	01	01	H0564_040_0	8	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
H0564	044	0	1	01	01	H0564_044_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
H0564	044	0	1	01	01	H0564_044_0	6	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
H0564	044	0	1	01	01	H0564_044_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
H0564	044	0	1	01	01	H0564_044_0	6	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
H0564	044	0	1	01	01	H0564_044_0	6	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
H0564	045	0	1	01	01	H0564_045_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
H0564	045	0	1	01	01	H0564_045_0	4	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
H0564	045	0	1	01	01	H0564_045_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
H0564	045	0	1	01	01	H0564_045_0	4	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
H0564	045	0	1	01	01	H0564_045_0	4	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
H0564	046	0	1	01	01	H0564_046_0	4	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
H0564	046	0	1	01	01	H0564_046_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
H0564	046	0	1	01	01	H0564_046_0	4	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
H0564	046	0	1	01	01	H0564_046_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
H0564	046	0	1	01	01	H0564_046_0	4	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
H0571	001	0	1	01	01	H0571_001_0	2	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	34	90								34				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	20.00								10.00				20.00									4
H0571	001	0	1	01	01	H0571_001_0	2	2	1	Formulary Brand	000010	1	2	Formulary Brand	011000000010001000000	34	90								34				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00				60.00									4
H0571	002	0	2	01	01	H0571_002_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	34	90								34				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	20.00								10.00				20.00									4
H0571	002	0	2	01	01	H0571_002_0	3	2	1	Formulary Brand	000010	1	2	Formulary Brand	011000000010001000000	34	90								34				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00				60.00									4
H0602	017	0	1	18	06	H0602_017_0	3	4	1	Specialty	010010		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							3
H0602	017	0	1	18	06	H0602_017_0	3	3	1	Non-Preferred Brand	100010		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									3
H0602	017	0	1	18	06	H0602_017_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									3
H0602	017	0	1	18	06	H0602_017_0	3	1	1	Generic	011100		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									3
H0602	017	0	1	18	06	H0602_017_0	3	5	1	Injectable	010010		1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							3
H0602	018	0	1	18	06	H0602_018_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	1	011000000011001000000		Generic	50	50								50	50			50								Generic																						1	4
H0602	018	0	1	18	06	H0602_018_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	1	011000000011001000000		Preferred Brand	50	50								50	50			50								Preferred Brand																						1	4
H0602	018	0	1	18	06	H0602_018_0	3	3	3	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	50	50								50	50			50								Non-Preferred Brand																						1	4
H0602	018	0	1	18	06	H0602_018_0	3	4	3	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	50	50								50	50			50								Specialty																						1	4
H0602	018	0	1	18	06	H0602_018_0	3	5	1	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							4
H0602	018	0	1	18	06	H0602_018_0	3	4	1	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							4
H0602	018	0	1	18	06	H0602_018_0	3	3	1	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									4
H0602	018	0	1	18	06	H0602_018_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									4
H0602	018	0	1	18	06	H0602_018_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									4
H0602	018	0	1	18	06	H0602_018_0	3	5	3	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	50	50								50	50			50								Injectable																						1	4
H0602	019	0	1	18	06	H0602_019_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									4
H0602	019	0	1	18	06	H0602_019_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									4
H0602	019	0	1	18	06	H0602_019_0	3	5	3	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	50	50								50	50			50								Injectable																						1	4
H0602	019	0	1	18	06	H0602_019_0	3	4	3	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	50	50								50	50			50								Specialty																						1	4
H0602	019	0	1	18	06	H0602_019_0	3	3	3	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	50	50								50	50			50								Non-Preferred Brand																						1	4
H0602	019	0	1	18	06	H0602_019_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	1	011000000011001000000		Preferred Brand	50	50								50	50			50								Preferred Brand																						1	4
H0602	019	0	1	18	06	H0602_019_0	3	3	1	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									4
H0602	019	0	1	18	06	H0602_019_0	3	4	1	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							4
H0602	019	0	1	18	06	H0602_019_0	3	5	1	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							4
H0602	019	0	1	18	06	H0602_019_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	1	011000000011001000000		Generic	50	50								50	50			50								Generic																						1	4
H0602	020	0	1	18	06	H0602_020_0	3	4	1	Specialty	010010		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							3
H0602	020	0	1	18	06	H0602_020_0	3	3	1	Non-Preferred Brand	100010		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									3
H0602	020	0	1	18	06	H0602_020_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									3
H0602	020	0	1	18	06	H0602_020_0	3	1	1	Generic	011100		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									3
H0602	020	0	1	18	06	H0602_020_0	3	5	1	Injectable	010010		1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							3
H0602	021	0	1	18	06	H0602_021_0	3	3	1	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									4
H0602	021	0	1	18	06	H0602_021_0	3	4	1	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							4
H0602	021	0	1	18	06	H0602_021_0	3	5	1	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							4
H0602	021	0	1	18	06	H0602_021_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	1	011000000011001000000		Generic	50	50								50	50			50								Generic																						1	4
H0602	021	0	1	18	06	H0602_021_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	1	011000000011001000000		Preferred Brand	50	50								50	50			50								Preferred Brand																						1	4
H0602	021	0	1	18	06	H0602_021_0	3	3	3	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	50	50								50	50			50								Non-Preferred Brand																						1	4
H0602	021	0	1	18	06	H0602_021_0	3	4	3	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	50	50								50	50			50								Specialty																						1	4
H0602	021	0	1	18	06	H0602_021_0	3	5	3	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	50	50								50	50			50								Injectable																						1	4
H0602	021	0	1	18	06	H0602_021_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									4
H0602	021	0	1	18	06	H0602_021_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									4
H0602	022	0	1	18	06	H0602_022_0	3	3	1	Non-Preferred Brand	100010		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									3
H0602	022	0	1	18	06	H0602_022_0	3	1	1	Generic	011100		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									3
H0602	022	0	1	18	06	H0602_022_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									3
H0602	022	0	1	18	06	H0602_022_0	3	4	1	Specialty	010010		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							3
H0602	022	0	1	18	06	H0602_022_0	3	5	1	Injectable	010010		1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							3
H0602	023	0	1	18	06	H0602_023_0	3	5	1	Injectable	010010		1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							3
H0602	023	0	1	18	06	H0602_023_0	3	4	1	Specialty	010010		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							3
H0602	023	0	1	18	06	H0602_023_0	3	3	1	Non-Preferred Brand	100010		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									3
H0602	023	0	1	18	06	H0602_023_0	3	1	1	Generic	011100		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									3
H0602	023	0	1	18	06	H0602_023_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									3
H0602	024	0	1	18	06	H0602_024_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	1	011000000011001000000		Preferred Brand	50	50								50	50			50								Preferred Brand																						1	4
H0602	024	0	1	18	06	H0602_024_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	1	011000000011001000000		Generic	50	50								50	50			50								Generic																						1	4
H0602	024	0	1	18	06	H0602_024_0	3	5	1	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							4
H0602	024	0	1	18	06	H0602_024_0	3	4	1	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							4
H0602	024	0	1	18	06	H0602_024_0	3	3	1	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									4
H0602	024	0	1	18	06	H0602_024_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									4
H0602	024	0	1	18	06	H0602_024_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									4
H0602	024	0	1	18	06	H0602_024_0	3	3	3	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	50	50								50	50			50								Non-Preferred Brand																						1	4
H0602	024	0	1	18	06	H0602_024_0	3	5	3	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	50	50								50	50			50								Injectable																						1	4
H0602	024	0	1	18	06	H0602_024_0	3	4	3	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	50	50								50	50			50								Specialty																						1	4
H0602	030	0	1	18	06	H0602_030_0	2	4	1	Specialty	010010		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							3
H0602	030	0	1	18	06	H0602_030_0	2	3	1	Non-Preferred Brand	100010		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									3
H0602	030	0	1	18	06	H0602_030_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									3
H0602	030	0	1	18	06	H0602_030_0	2	1	1	Generic	011100		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									3
H0602	030	0	1	18	06	H0602_030_0	2	5	1	Injectable	010010		1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							3
H0602	031	0	1	18	06	H0602_031_0	2	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	1	011000000011001000000		Generic	50	50								50	50			50								Generic																						1	4
H0602	031	0	1	18	06	H0602_031_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	1	011000000011001000000		Preferred Brand	50	50								50	50			50								Preferred Brand																						1	4
H0602	031	0	1	18	06	H0602_031_0	2	4	3	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	50	50								50	50			50								Specialty																						1	4
H0602	031	0	1	18	06	H0602_031_0	2	3	3	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	50	50								50	50			50								Non-Preferred Brand																						1	4
H0602	031	0	1	18	06	H0602_031_0	2	5	1	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							4
H0602	031	0	1	18	06	H0602_031_0	2	4	1	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							4
H0602	031	0	1	18	06	H0602_031_0	2	5	3	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	50	50								50	50			50								Injectable																						1	4
H0602	031	0	1	18	06	H0602_031_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	38.00	114.00								38.00	114.00			76.00									4
H0602	031	0	1	18	06	H0602_031_0	2	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	8.00	24.00								8.00	24.00			16.00									4
H0602	031	0	1	18	06	H0602_031_0	2	3	1	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00			116.00									4
H0609	002	0	1	01	01	H0609_002_0	7	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0609	002	0	1	01	01	H0609_002_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0609	002	0	1	01	01	H0609_002_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0609	002	0	1	01	01	H0609_002_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0609	002	0	1	01	01	H0609_002_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0609	002	0	1	01	01	H0609_002_0	7	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H0609	002	0	1	01	01	H0609_002_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0609	002	0	1	01	01	H0609_002_0	7	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0609	003	0	1	01	01	H0609_003_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0609	003	0	1	01	01	H0609_003_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0609	003	0	1	01	01	H0609_003_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0609	003	0	1	01	01	H0609_003_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0609	006	0	1	01	01	H0609_006_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0609	006	0	1	01	01	H0609_006_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0609	006	0	1	01	01	H0609_006_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0609	006	0	1	01	01	H0609_006_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0609	007	0	1	01	01	H0609_007_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0609	007	0	1	01	01	H0609_007_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0609	007	0	1	01	01	H0609_007_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0609	007	0	1	01	01	H0609_007_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0609	011	0	1	01	01	H0609_011_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0609	011	0	1	01	01	H0609_011_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0609	011	0	1	01	01	H0609_011_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0609	011	0	1	01	01	H0609_011_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0609	012	0	1	01	01	H0609_012_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0609	012	0	1	01	01	H0609_012_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0609	012	0	1	01	01	H0609_012_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0609	012	0	1	01	01	H0609_012_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0609	013	0	1	01	01	H0609_013_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0609	013	0	1	01	01	H0609_013_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0609	013	0	1	01	01	H0609_013_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0609	013	0	1	01	01	H0609_013_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0609	014	0	1	01	01	H0609_014_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0609	014	0	1	01	01	H0609_014_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0609	014	0	1	01	01	H0609_014_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0609	014	0	1	01	01	H0609_014_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0609	020	0	1	01	01	H0609_020_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H0609	020	0	1	01	01	H0609_020_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H0609	020	0	1	01	01	H0609_020_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H0609	020	0	1	01	01	H0609_020_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H0620	002	0	1	04	01	H0620_002_0	7	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H0620	002	0	1	04	01	H0620_002_0	7	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H0620	002	0	1	04	01	H0620_002_0	7	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H0620	002	0	1	04	01	H0620_002_0	7	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H0623	001	0	1	04	01	H0623_001_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H0623	001	0	1	04	01	H0623_001_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H0623	001	0	1	04	01	H0623_001_0	4	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0623	001	0	1	04	01	H0623_001_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H0623	001	0	1	04	01	H0623_001_0	4	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H0623	001	0	1	04	01	H0623_001_0	4	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0623	001	0	1	04	01	H0623_001_0	4	3	3	Other Non-Preferred	100100	1	2	Other Non-Preferred																							Other Non-Preferred					Other Non-Preferred																						Other Non-Preferred																						2	4
H0623	001	0	1	04	01	H0623_001_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H0623	002	0	1	04	01	H0623_002_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H0623	002	0	1	04	01	H0623_002_0	4	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0623	002	0	1	04	01	H0623_002_0	4	3	3	Other Non-Preferred	100100	1	2	Other Non-Preferred																							Other Non-Preferred					Other Non-Preferred																						Other Non-Preferred																						2	4
H0623	002	0	1	04	01	H0623_002_0	4	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0623	002	0	1	04	01	H0623_002_0	4	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H0623	002	0	1	04	01	H0623_002_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H0623	002	0	1	04	01	H0623_002_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H0623	002	0	1	04	01	H0623_002_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H0623	003	0	1	04	01	H0623_003_0	4	3	3	Other Non-Preferred	100100	1	2	Other Non-Preferred																							Other Non-Preferred					Other Non-Preferred																						Other Non-Preferred																						2	4
H0623	003	0	1	04	01	H0623_003_0	4	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0623	003	0	1	04	01	H0623_003_0	4	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H0623	003	0	1	04	01	H0623_003_0	4	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0623	003	0	1	04	01	H0623_003_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H0623	003	0	1	04	01	H0623_003_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H0623	003	0	1	04	01	H0623_003_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H0623	003	0	1	04	01	H0623_003_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H0624	001	0	1	01	01	H0624_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0624	001	0	1	01	01	H0624_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0624	001	0	1	01	01	H0624_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0624	001	0	1	01	01	H0624_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0624	002	0	1	01	01	H0624_002_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0624	002	0	1	01	01	H0624_002_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H0624	002	0	1	01	01	H0624_002_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0624	002	0	1	01	01	H0624_002_0	8	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H0624	004	0	1	01	01	H0624_004_0	7	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H0624	004	0	1	01	01	H0624_004_0	7	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H0624	004	0	1	01	01	H0624_004_0	7	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H0624	004	0	1	01	01	H0624_004_0	7	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H0630	013	0	1	01	01	H0630_013_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	010100000010010100000	30		90							30			30		90							Preferred Generic	2	2		010100000010010100000	Preferred Generic																						Preferred Generic	10.00		30.00							10.00			10.00		20.00								3
H0630	013	0	1	01	01	H0630_013_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	010100000010010100000	30		90							30			30		90							Preferred Brand	2	2		010100000010010100000	Preferred Brand																						Preferred Brand	30.00		90.00							30.00			30.00		60.00								3
H0630	015	0	1	01	01	H0630_015_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	010100000010010100000	30		90							30			30		90							Preferred Generic	2	2		010100000010010100000	Preferred Generic																						Preferred Generic	10.00		30.00							10.00			10.00		20.00								4
H0630	015	0	1	01	01	H0630_015_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010100000010010100000	30		90							30			30		90							Preferred Brand	2	2		010100000010010100000	Preferred Brand																						Preferred Brand	30.00		90.00							30.00			30.00		60.00								4
H0630	016	0	1	01	01	H0630_016_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	010100000010010100000	30		90							30			30		90							Preferred Generic	2	2		010100000010010100000	Preferred Generic																						Preferred Generic	10.00		30.00							10.00			10.00		20.00								4
H0630	016	0	1	01	01	H0630_016_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010100000010010100000	30		90							30			30		90							Preferred Brand	2	2		010100000010010100000	Preferred Brand																						Preferred Brand	25.00		75.00							25.00			25.00		50.00								4
H0630	016	0	1	01	01	H0630_016_0	3	1	3	Preferred Generic	001000	1	2	Preferred Generic	010100000010010100000	30		90							30			30		90							Preferred Generic	2	2		010100000010010100000	Preferred Generic																						Preferred Generic	10.00		30.00							10.00			10.00		20.00							1	4
H0630	016	0	1	01	01	H0630_016_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0710	001	0	1	04	01	H0710_001_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H0710	001	0	1	04	01	H0710_001_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H0710	001	0	1	04	01	H0710_001_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H0710	001	0	1	04	01	H0710_001_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H0710	002	0	1	04	01	H0710_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0710	002	0	1	04	01	H0710_002_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0710	002	0	1	04	01	H0710_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0710	002	0	1	04	01	H0710_002_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0710	003	0	1	04	01	H0710_003_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0710	003	0	1	04	01	H0710_003_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H0710	003	0	1	04	01	H0710_003_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H0710	003	0	1	04	01	H0710_003_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H0712	001	0	1	01	01	H0712_001_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H0712	001	0	1	01	01	H0712_001_0	7	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H0712	001	0	1	01	01	H0712_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H0712	001	0	1	01	01	H0712_001_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H0712	017	0	1	01	01	H0712_017_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H0712	017	0	1	01	01	H0712_017_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H0712	017	0	1	01	01	H0712_017_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00			15.00								1	4
H0712	017	0	1	01	01	H0712_017_0	6	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H0712	017	0	1	01	01	H0712_017_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	65.00	195.00								65.00	195.00			195.00									4
H0712	017	0	1	01	01	H0712_017_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H0712	017	0	1	01	01	H0712_017_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00			15.00									4
H0712	017	0	1	01	01	H0712_017_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H0752	002	0	1	01	01	H0752_002_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H0752	002	0	1	01	01	H0752_002_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H0752	002	0	1	01	01	H0752_002_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H0752	002	0	1	01	01	H0752_002_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H0755	001	0	1	01	01	H0755_001_0	5	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H0755	001	0	1	01	01	H0755_001_0	5	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
H0755	001	0	1	01	01	H0755_001_0	5	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H0755	001	0	1	01	01	H0755_001_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H0755	001	0	1	01	01	H0755_001_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H0755	001	0	1	01	01	H0755_001_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	63.00	189.00	126.00							63.00	189.00	126.00		158.00	126.00								4
H0755	001	0	1	01	01	H0755_001_0	5	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H0755	001	0	1	01	01	H0755_001_0	5	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H0755	001	0	1	01	01	H0755_001_0	5	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00							1	4
H0755	001	0	1	01	01	H0755_001_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	33.00	99.00	66.00							33.00	99.00	66.00		66.00	66.00								4
H0755	020	0	1	02	01	H0755_020_0	6	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
H0755	020	0	1	02	01	H0755_020_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	30		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	33.00	99.00	66.00							33.00	99.00	66.00		66.00	66.00								3
H0755	020	0	1	02	01	H0755_020_0	6	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	63.00	189.00	126.00							63.00	189.00	126.00		158.00	126.00								3
H0755	020	0	1	02	01	H0755_020_0	6	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
H0755	020	0	1	02	01	H0755_020_0	6	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
H0755	021	0	1	01	01	H0755_021_0	6	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
H0755	021	0	1	01	01	H0755_021_0	6	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	50.00	150.00	100.00							50.00	150.00	100.00		125.00	100.00								3
H0755	021	0	1	01	01	H0755_021_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	26.00	78.00	52.00							26.00	78.00	52.00		52.00	52.00								3
H0755	021	0	1	01	01	H0755_021_0	6	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
H0755	021	0	1	01	01	H0755_021_0	6	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
H0755	022	0	1	01	01	H0755_022_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
H0755	022	0	1	01	01	H0755_022_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	30		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	33.00	99.00	66.00							33.00	99.00	66.00		66.00	66.00								3
H0755	022	0	1	01	01	H0755_022_0	4	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	63.00	189.00	126.00							63.00	189.00	126.00		158.00	126.00								3
H0755	022	0	1	01	01	H0755_022_0	4	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
H0755	022	0	1	01	01	H0755_022_0	4	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
H0755	024	0	1	01	01	H0755_024_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	30		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	33.00	99.00	66.00							33.00	99.00	66.00		66.00	66.00								3
H0755	024	0	1	01	01	H0755_024_0	4	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
H0755	024	0	1	01	01	H0755_024_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
H0755	024	0	1	01	01	H0755_024_0	4	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	63.00	189.00	126.00							63.00	189.00	126.00		158.00	126.00								3
H0755	024	0	1	01	01	H0755_024_0	4	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
H0901	002	0	1	01	01	H0901_002_0	5	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0901	002	0	1	01	01	H0901_002_0	5	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H0901	002	0	1	01	01	H0901_002_0	5	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H0901	002	0	1	01	01	H0901_002_0	5	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H0901	002	0	1	01	01	H0901_002_0	5	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0901	002	0	1	01	01	H0901_002_0	5	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H0901	002	0	1	01	01	H0901_002_0	5	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H0901	002	0	1	01	01	H0901_002_0	5	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H0901	003	0	1	01	01	H0901_003_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H0901	003	0	1	01	01	H0901_003_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H0901	003	0	1	01	01	H0901_003_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H0901	004	0	1	01	01	H0901_004_0	4	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0901	004	0	1	01	01	H0901_004_0	4	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0901	004	0	1	01	01	H0901_004_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H0901	004	0	1	01	01	H0901_004_0	4	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H0901	004	0	1	01	01	H0901_004_0	4	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H0901	004	0	1	01	01	H0901_004_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H0902	002	0	1	04	01	H0902_002_0	7	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H0902	002	0	1	04	01	H0902_002_0	7	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0902	002	0	1	04	01	H0902_002_0	7	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0902	002	0	1	04	01	H0902_002_0	7	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H0902	002	0	1	04	01	H0902_002_0	7	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H0902	002	0	1	04	01	H0902_002_0	7	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H0902	002	0	1	04	01	H0902_002_0	7	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H0902	002	0	1	04	01	H0902_002_0	7	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H0902	003	0	1	04	01	H0902_003_0	7	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H0902	003	0	1	04	01	H0902_003_0	7	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H0902	003	0	1	04	01	H0902_003_0	7	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H0902	003	0	1	04	01	H0902_003_0	7	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H0902	003	0	1	04	01	H0902_003_0	7	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H0902	003	0	1	04	01	H0902_003_0	7	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H1013	011	0	1	01	01	H1013_011_0	6	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H1013	011	0	1	01	01	H1013_011_0	6	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H1013	011	0	1	01	01	H1013_011_0	6	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1013	011	0	1	01	01	H1013_011_0	6	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1013	011	0	1	01	01	H1013_011_0	6	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H1013	011	0	1	01	01	H1013_011_0	6	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H1013	011	0	1	01	01	H1013_011_0	6	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				30.00			30.00			30.00													4
H1013	011	0	1	01	01	H1013_011_0	6	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1013	021	0	1	01	01	H1013_021_0	4	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H1013	021	0	1	01	01	H1013_021_0	4	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H1013	021	0	1	01	01	H1013_021_0	4	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H1013	021	0	1	01	01	H1013_021_0	4	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				40.00			40.00			40.00													4
H1013	021	0	1	01	01	H1013_021_0	4	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				20.00	60.00	40.00	20.00			20.00			20.00	60.00	40.00								4
H1013	021	0	1	01	01	H1013_021_0	4	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1013	021	0	1	01	01	H1013_021_0	4	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H1013	021	0	1	01	01	H1013_021_0	4	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1013	022	0	1	01	01	H1013_022_0	4	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1013	022	0	1	01	01	H1013_022_0	4	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H1013	022	0	1	01	01	H1013_022_0	4	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H1013	022	0	1	01	01	H1013_022_0	4	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H1013	022	0	1	01	01	H1013_022_0	4	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				23.00	69.00	46.00	23.00			23.00			23.00	69.00	46.00								4
H1013	022	0	1	01	01	H1013_022_0	4	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				50.00			50.00			50.00													4
H1013	022	0	1	01	01	H1013_022_0	4	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H1013	022	0	1	01	01	H1013_022_0	4	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1013	023	0	1	01	01	H1013_023_0	4	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H1013	023	0	1	01	01	H1013_023_0	4	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1013	023	0	1	01	01	H1013_023_0	4	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				20.00	60.00	40.00	20.00			20.00			20.00	60.00	40.00								4
H1013	023	0	1	01	01	H1013_023_0	4	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				40.00			40.00			40.00													4
H1013	023	0	1	01	01	H1013_023_0	4	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1013	023	0	1	01	01	H1013_023_0	4	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H1013	023	0	1	01	01	H1013_023_0	4	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H1013	023	0	1	01	01	H1013_023_0	4	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H1013	026	0	1	02	01	H1013_026_0	6	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H1013	026	0	1	02	01	H1013_026_0	6	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				120.00			120.00			120.00													4
H1013	026	0	1	02	01	H1013_026_0	6	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1013	026	0	1	02	01	H1013_026_0	6	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				40.00	120.00	80.00	40.00			40.00			40.00	120.00	80.00								4
H1016	001	0	1	01	01	H1016_001_0	7	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	1	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H1016	001	0	1	01	01	H1016_001_0	7	2	1	Preferred Brand Name	000001	1	2	Preferred Brand Name	011000000010001000000	30	90								30				90								Preferred Brand Name	1	2		011000000010001000000	Preferred Brand Name																						Preferred Brand Name	15.00	45.00								15.00				45.00									4
H1016	001	0	1	01	01	H1016_001_0	7	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1016	001	0	1	01	01	H1016_001_0	7	3	3	Non-Preferred Brand Name	100000	1	2	Non-Preferred Brand Name																							Non-Preferred Brand Name					Non-Preferred Brand Name																						Non-Preferred Brand Name																						2	4
H1016	001	0	1	01	01	H1016_001_0	7	2	3	Preferred Brand Name	000001	1	2	Preferred Brand Name																							Preferred Brand Name					Preferred Brand Name																						Preferred Brand Name																						2	4
H1016	001	0	1	01	01	H1016_001_0	7	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	1	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00								1	4
H1016	001	0	1	01	01	H1016_001_0	7	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	1	1	010000000010000000000		Specialty	33									33												Specialty																							4
H1016	001	0	1	01	01	H1016_001_0	7	3	1	Non-Preferred Brand Name	100000	1	2	Non-Preferred Brand Name	011000000010001000000	30	90								30				90								Non-Preferred Brand Name	1	2		011000000010001000000	Non-Preferred Brand Name																						Non-Preferred Brand Name	35.00	105.00								35.00				105.00									4
H1016	002	0	1	01	01	H1016_002_0	9	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	1	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									4
H1016	002	0	1	01	01	H1016_002_0	9	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	1	1	010000000010000000000		Specialty	33									33												Specialty																							4
H1016	002	0	1	01	01	H1016_002_0	9	3	1	Non-Preferred Brand Name	100000	1	2	Non-Preferred Brand Name	011000000010001000000	30	90								30				90								Non-Preferred Brand Name	1	2		011000000010001000000	Non-Preferred Brand Name																						Non-Preferred Brand Name	50.00	150.00								50.00				150.00									4
H1016	002	0	1	01	01	H1016_002_0	9	2	1	Preferred Brand Name	000001	1	2	Preferred Brand Name	011000000010001000000	30	90								30				90								Preferred Brand Name	1	2		011000000010001000000	Preferred Brand Name																						Preferred Brand Name	25.00	75.00								25.00				75.00									4
H1016	017	0	2	01	01	H1016_017_0	8	3	1	Non-Preferred Brand Name	100000		2	Non-Preferred Brand Name	011000000010001000000	30	90								30				90								Non-Preferred Brand Name	1	2		011000000010001000000	Non-Preferred Brand Name																						Non-Preferred Brand Name	50.00	150.00								50.00				150.00									3
H1016	017	0	2	01	01	H1016_017_0	8	2	1	Preferred Brand Name	000001		2	Preferred Brand Name	011000000010001000000	30	90								30				90								Preferred Brand Name	1	2		011000000010001000000	Preferred Brand Name																						Preferred Brand Name	25.00	75.00								25.00				75.00									3
H1016	017	0	2	01	01	H1016_017_0	8	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	1	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									3
H1016	017	0	2	01	01	H1016_017_0	8	4	1	Specialty	010010		1	Specialty	010000000010000000000	30									30												Specialty	1	1	010000000010000000000		Specialty	33									33												Specialty																							3
H1019	001	0	1	01	01	H1019_001_0	3	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1019	001	0	1	01	01	H1019_001_0	3	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	50.00									4
H1019	001	0	1	01	01	H1019_001_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H1019	001	0	1	01	01	H1019_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1019	001	0	1	01	01	H1019_001_0	3	1	3	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00								1	4
H1019	001	0	1	01	01	H1019_001_0	3	2	3	Preferred Brand	010001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1019	001	0	1	01	01	H1019_001_0	3	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1019	001	0	1	01	01	H1019_001_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1019	002	0	1	01	01	H1019_002_0	3	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1019	002	0	1	01	01	H1019_002_0	3	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	0.00	0.00								0.00			0.00	0.00									4
H1019	002	0	1	01	01	H1019_002_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1019	002	0	1	01	01	H1019_002_0	3	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1019	002	0	1	01	01	H1019_002_0	3	2	3	Preferred Brand	010001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1019	002	0	1	01	01	H1019_002_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	40.00	120.00								40.00			40.00	100.00									4
H1019	002	0	1	01	01	H1019_002_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1019	002	0	1	01	01	H1019_002_0	3	1	3	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00								1	4
H1019	005	0	1	01	01	H1019_005_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1019	005	0	1	01	01	H1019_005_0	4	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1019	005	0	1	01	01	H1019_005_0	4	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1019	005	0	1	01	01	H1019_005_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1019	006	0	1	01	01	H1019_006_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	40.00	120.00								40.00			40.00	100.00									4
H1019	006	0	1	01	01	H1019_006_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1019	006	0	1	01	01	H1019_006_0	3	1	3	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00								1	4
H1019	006	0	1	01	01	H1019_006_0	3	2	3	Preferred Brand	010001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1019	006	0	1	01	01	H1019_006_0	3	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1019	006	0	1	01	01	H1019_006_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1019	006	0	1	01	01	H1019_006_0	3	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1019	006	0	1	01	01	H1019_006_0	3	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	0.00	0.00								0.00			0.00	0.00									4
H1019	010	0	1	01	01	H1019_010_0	4	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00								1	4
H1019	010	0	1	01	01	H1019_010_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1019	010	0	1	01	01	H1019_010_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1019	010	0	1	01	01	H1019_010_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1019	010	0	1	01	01	H1019_010_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1019	010	0	1	01	01	H1019_010_0	4	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1019	010	0	1	01	01	H1019_010_0	4	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1019	010	0	1	01	01	H1019_010_0	4	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1019	011	0	1	01	01	H1019_011_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1019	011	0	1	01	01	H1019_011_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	75.00	225.00								75.00			75.00	187.50									4
H1019	011	0	1	01	01	H1019_011_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1019	011	0	1	01	01	H1019_011_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1019	014	0	1	01	01	H1019_014_0	3	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010010000000	30	90								30			30									Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00								1	4
H1019	014	0	1	01	01	H1019_014_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1019	014	0	1	01	01	H1019_014_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1019	014	0	1	01	01	H1019_014_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	50.00									4
H1019	014	0	1	01	01	H1019_014_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1019	014	0	1	01	01	H1019_014_0	3	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1019	014	0	1	01	01	H1019_014_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1019	014	0	1	01	01	H1019_014_0	3	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1019	023	0	1	01	01	H1019_023_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1019	023	0	1	01	01	H1019_023_0	4	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1019	023	0	1	01	01	H1019_023_0	4	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1019	023	0	1	01	01	H1019_023_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1019	024	0	1	01	01	H1019_024_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1019	024	0	1	01	01	H1019_024_0	6	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1019	024	0	1	01	01	H1019_024_0	6	1	1	Other = Preferred Generic & Select Brand	011001	1	2	Other = Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other = Preferred Generic & Select Brand	2	2		011000000010011000000	Other = Preferred Generic & Select Brand																						Other = Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1019	024	0	1	01	01	H1019_024_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1019	025	0	1	01	01	H1019_025_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1019	025	0	1	01	01	H1019_025_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1019	025	0	1	01	01	H1019_025_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1019	025	0	1	01	01	H1019_025_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	28									28			28									Specialty																							4
H1019	026	0	1	01	01	H1019_026_0	6	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1019	026	0	1	01	01	H1019_026_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1019	026	0	1	01	01	H1019_026_0	6	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1019	026	0	1	01	01	H1019_026_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	28									28			28									Specialty																							4
H1026	001	0	1	01	01	H1026_001_0	2	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
H1026	001	0	1	01	01	H1026_001_0	2	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 2 Preferred Brand	2	2		011100000011111100000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	25.00	75.00	50.00							25.00	75.00	50.00	25.00	75.00	50.00								4
H1026	001	0	1	01	01	H1026_001_0	2	3	1	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 3 Non-Preferred Brand	2	2		011100000011111100000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H1026	001	0	1	01	01	H1026_001_0	2	4	1	Tier 4 Specialty	110001	1	1	Tier 4 Specialty	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 4 Specialty	2	1	011100000011111100000		Tier 4 Specialty	25	25	25							25	25	25	25	25	25							Tier 4 Specialty																							4
H1026	001	0	1	01	01	H1026_001_0	2	5	3	Excluded Generic	010000	2	2	Excluded Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Excluded Generic	2	2		011100000011111100000	Excluded Generic																						Excluded Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00							1	4
H1026	001	0	1	01	01	H1026_001_0	2	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00							1	4
H1026	001	0	1	01	01	H1026_001_0	2	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H1026	001	0	1	01	01	H1026_001_0	2	3	3	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H1026	001	0	1	01	01	H1026_001_0	2	4	3	Tier 4 Specialty	110001	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H1026	001	0	1	01	01	H1026_001_0	2	5	1	Excluded Generic	010000	2	2	Excluded Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Excluded Generic	2	2		011100000011111100000	Excluded Generic																						Excluded Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
H1032	002	0	1	01	01	H1032_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	002	0	1	01	01	H1032_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H1032	002	0	1	01	01	H1032_002_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H1032	002	0	1	01	01	H1032_002_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	002	0	1	01	01	H1032_002_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	002	0	1	01	01	H1032_002_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	002	0	1	01	01	H1032_002_0	4	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	002	0	1	01	01	H1032_002_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	004	0	1	01	01	H1032_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	004	0	1	01	01	H1032_004_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H1032	004	0	1	01	01	H1032_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H1032	004	0	1	01	01	H1032_004_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	008	0	1	01	01	H1032_008_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	008	0	1	01	01	H1032_008_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	0.00	0.00								0.00	0.00			0.00									4
H1032	008	0	1	01	01	H1032_008_0	4	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	008	0	1	01	01	H1032_008_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	008	0	1	01	01	H1032_008_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	008	0	1	01	01	H1032_008_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	008	0	1	01	01	H1032_008_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	008	0	1	01	01	H1032_008_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	40.00	120.00								40.00	120.00			120.00									4
H1032	010	0	1	01	01	H1032_010_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	010	0	1	01	01	H1032_010_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	010	0	1	01	01	H1032_010_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	010	0	1	01	01	H1032_010_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	010	0	1	01	01	H1032_010_0	6	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	010	0	1	01	01	H1032_010_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	010	0	1	01	01	H1032_010_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	25.00	75.00								25.00	75.00			75.00									4
H1032	010	0	1	01	01	H1032_010_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	012	0	1	01	01	H1032_012_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	012	0	1	01	01	H1032_012_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	15.00	45.00								15.00	45.00			45.00									4
H1032	012	0	1	01	01	H1032_012_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	50.00	150.00								50.00	150.00			150.00									4
H1032	012	0	1	01	01	H1032_012_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	012	0	1	01	01	H1032_012_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	012	0	1	01	01	H1032_012_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	012	0	1	01	01	H1032_012_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	012	0	1	01	01	H1032_012_0	4	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	014	0	1	01	01	H1032_014_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	014	0	1	01	01	H1032_014_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
H1032	014	0	1	01	01	H1032_014_0	4	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	014	0	1	01	01	H1032_014_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	014	0	1	01	01	H1032_014_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	014	0	1	01	01	H1032_014_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	014	0	1	01	01	H1032_014_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	014	0	1	01	01	H1032_014_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H1032	019	0	1	01	01	H1032_019_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	25.00	75.00								25.00	75.00			75.00									4
H1032	019	0	1	01	01	H1032_019_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	50.00	150.00								50.00	150.00			150.00									4
H1032	019	0	1	01	01	H1032_019_0	6	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	019	0	1	01	01	H1032_019_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	019	0	1	01	01	H1032_019_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	019	0	1	01	01	H1032_019_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	019	0	1	01	01	H1032_019_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	019	0	1	01	01	H1032_019_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	025	0	1	01	01	H1032_025_0	6	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	025	0	1	01	01	H1032_025_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	025	0	1	01	01	H1032_025_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	025	0	1	01	01	H1032_025_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	028	0	1	01	01	H1032_028_0	11	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H1032	028	0	1	01	01	H1032_028_0	11	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H1032	028	0	1	01	01	H1032_028_0	11	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	028	0	1	01	01	H1032_028_0	11	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	028	0	1	01	01	H1032_028_0	11	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	028	0	1	01	01	H1032_028_0	11	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	028	0	1	01	01	H1032_028_0	11	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	028	0	1	01	01	H1032_028_0	11	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	029	0	1	01	01	H1032_029_0	7	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	029	0	1	01	01	H1032_029_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	029	0	1	01	01	H1032_029_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	029	0	1	01	01	H1032_029_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	029	0	1	01	01	H1032_029_0	7	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	029	0	1	01	01	H1032_029_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	029	0	1	01	01	H1032_029_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	029	0	1	01	01	H1032_029_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	031	0	1	01	01	H1032_031_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	031	0	1	01	01	H1032_031_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	031	0	1	01	01	H1032_031_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	031	0	1	01	01	H1032_031_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	032	0	1	01	01	H1032_032_0	2	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	032	0	1	01	01	H1032_032_0	2	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	032	0	1	01	01	H1032_032_0	2	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	032	0	1	01	01	H1032_032_0	2	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	033	0	1	01	01	H1032_033_0	6	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	033	0	1	01	01	H1032_033_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	033	0	1	01	01	H1032_033_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	033	0	1	01	01	H1032_033_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	033	0	1	01	01	H1032_033_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	033	0	1	01	01	H1032_033_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	033	0	1	01	01	H1032_033_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	033	0	1	01	01	H1032_033_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	035	0	1	01	01	H1032_035_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	035	0	1	01	01	H1032_035_0	7	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	035	0	1	01	01	H1032_035_0	7	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	035	0	1	01	01	H1032_035_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	035	0	1	01	01	H1032_035_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	035	0	1	01	01	H1032_035_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	035	0	1	01	01	H1032_035_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	035	0	1	01	01	H1032_035_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	036	0	1	01	01	H1032_036_0	3	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	036	0	1	01	01	H1032_036_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	036	0	1	01	01	H1032_036_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	036	0	1	01	01	H1032_036_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	040	0	1	01	01	H1032_040_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	040	0	1	01	01	H1032_040_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	25.00	75.00								25.00	75.00			75.00									4
H1032	040	0	1	01	01	H1032_040_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H1032	040	0	1	01	01	H1032_040_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	041	0	1	01	01	H1032_041_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	041	0	1	01	01	H1032_041_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	041	0	1	01	01	H1032_041_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	041	0	1	01	01	H1032_041_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	042	0	1	01	01	H1032_042_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	042	0	1	01	01	H1032_042_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	042	0	1	01	01	H1032_042_0	4	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	042	0	1	01	01	H1032_042_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	042	0	1	01	01	H1032_042_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	042	0	1	01	01	H1032_042_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
H1032	042	0	1	01	01	H1032_042_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	50.00	150.00								50.00	150.00			150.00									4
H1032	042	0	1	01	01	H1032_042_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	043	0	1	01	01	H1032_043_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	043	0	1	01	01	H1032_043_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	043	0	1	01	01	H1032_043_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	043	0	1	01	01	H1032_043_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	044	0	1	01	01	H1032_044_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	044	0	1	01	01	H1032_044_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	044	0	1	01	01	H1032_044_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	044	0	1	01	01	H1032_044_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	069	0	1	01	01	H1032_069_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	069	0	1	01	01	H1032_069_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	069	0	1	01	01	H1032_069_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	069	0	1	01	01	H1032_069_0	7	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	070	0	1	01	01	H1032_070_0	4	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	070	0	1	01	01	H1032_070_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	070	0	1	01	01	H1032_070_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H1032	070	0	1	01	01	H1032_070_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	070	0	1	01	01	H1032_070_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	070	0	1	01	01	H1032_070_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	070	0	1	01	01	H1032_070_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	070	0	1	01	01	H1032_070_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	073	0	1	01	01	H1032_073_0	7	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	073	0	1	01	01	H1032_073_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	073	0	1	01	01	H1032_073_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	073	0	1	01	01	H1032_073_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	073	0	1	01	01	H1032_073_0	7	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	073	0	1	01	01	H1032_073_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
H1032	073	0	1	01	01	H1032_073_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	073	0	1	01	01	H1032_073_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	079	0	1	01	01	H1032_079_0	7	3	1	Tier 3	000100	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H1032	079	0	1	01	01	H1032_079_0	7	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1032	079	0	1	01	01	H1032_079_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	079	0	1	01	01	H1032_079_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00			90.00									4
H1032	079	0	1	01	01	H1032_079_0	7	3	3	Tier 3	000100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1032	079	0	1	01	01	H1032_079_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1032	079	0	1	01	01	H1032_079_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1032	079	0	1	01	01	H1032_079_0	7	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	091	0	1	01	01	H1032_091_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	091	0	1	01	01	H1032_091_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	091	0	1	01	01	H1032_091_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	091	0	1	01	01	H1032_091_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	092	0	1	01	01	H1032_092_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	092	0	1	01	01	H1032_092_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	092	0	1	01	01	H1032_092_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	092	0	1	01	01	H1032_092_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	097	0	1	01	01	H1032_097_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	097	0	1	01	01	H1032_097_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	097	0	1	01	01	H1032_097_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	097	0	1	01	01	H1032_097_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	098	0	1	01	01	H1032_098_0	5	3	1	Tier 3	000100	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	098	0	1	01	01	H1032_098_0	5	2	1	Tier 2	001000	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	098	0	1	01	01	H1032_098_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	098	0	1	01	01	H1032_098_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	113	0	1	01	01	H1032_113_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	113	0	1	01	01	H1032_113_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	113	0	1	01	01	H1032_113_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	113	0	1	01	01	H1032_113_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	129	0	1	01	01	H1032_129_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	129	0	1	01	01	H1032_129_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	129	0	1	01	01	H1032_129_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	129	0	1	01	01	H1032_129_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	131	0	1	01	01	H1032_131_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	131	0	1	01	01	H1032_131_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	131	0	1	01	01	H1032_131_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	131	0	1	01	01	H1032_131_0	6	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	132	0	1	01	01	H1032_132_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	132	0	1	01	01	H1032_132_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H1032	132	0	1	01	01	H1032_132_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	132	0	1	01	01	H1032_132_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1032	133	0	1	01	01	H1032_133_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1032	133	0	1	01	01	H1032_133_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1032	133	0	1	01	01	H1032_133_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1032	133	0	1	01	01	H1032_133_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1035	002	0	1	02	01	H1035_002_0	7	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	000011011010000001000				31	93		31	93		31							93					Formulary Preferred Brand	2	1	000011011010000001000		Formulary Preferred Brand				25	25		50	50		25							25					Formulary Preferred Brand																							4
H1035	002	0	1	02	01	H1035_002_0	7	5	1	Benzodiazepine/Phenobarbital/Cough Supp&Vita/DESI	010000	2	2	Benzodiazepine/Phenobarbital/Cough Supp&Vita/DESI	000011000010000001000				31	93					31							93					Benzodiazepine/Phenobarbital/Cough Supp&Vita/DESI	2	2		000011000010000001000	Benzodiazepine/Phenobarbital/Cough Supp&Vita/DESI																						Benzodiazepine/Phenobarbital/Cough Supp&Vita/DESI				10.00	30.00					10.00							27.00						4
H1035	002	0	1	02	01	H1035_002_0	7	4	1	Part B/D Drugs	010010	1	2	Part B/D Drugs	000011000010000001000				31	93					31							93					Part B/D Drugs	2	1	000011000010000001000		Part B/D Drugs				25	25					25							25					Part B/D Drugs																							4
H1035	002	0	1	02	01	H1035_002_0	7	3	1	Non-Preferred Formulary Brand	100000	1	2	Non-Preferred Formulary Brand	000011011010000001000				31	93		31	93		31							93					Non-Preferred Formulary Brand	2	1	000011011010000001000		Non-Preferred Formulary Brand				50	50		75	75		50							50					Non-Preferred Formulary Brand																							4
H1035	002	0	1	02	01	H1035_002_0	7	1	1	Formulary Generic	010000	1	2	Formulary Generic	000011011010000001000				31	93		31	93		31							93					Formulary Generic	2	2		000011011010000001000	Formulary Generic																						Formulary Generic				3.00	9.00		10.00	30.00		3.00							6.00						4
H1035	006	0	1	02	01	H1035_006_0	6	1	1	Formulary Generic	010000		2	Formulary Generic	000011011001000001000				31	93		31	93			93						93					Formulary Generic	2	1	000011011001000001000		Formulary Generic				20	20		30	30			20						20					Formulary Generic																							2
H1035	006	0	1	02	01	H1035_006_0	6	4	1	Part B/D Drugs	010010		2	Part B/D Drugs	000011000001000001000				31	93						93						93					Part B/D Drugs	2	1	000011000001000001000		Part B/D Drugs				25	25						25						25					Part B/D Drugs																							2
H1035	006	0	1	02	01	H1035_006_0	6	3	1	Non-Preferred Formulary Brand	100000		2	Non-Preferred Formulary Brand	000011011001000001000				31	93		31	93			93						93					Non-Preferred Formulary Brand	2	1	000011011001000001000		Non-Preferred Formulary Brand				40	40		50	50			40						40					Non-Preferred Formulary Brand																							2
H1035	006	0	1	02	01	H1035_006_0	6	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	000011011001000001000				31	93		31	93			93						93					Formulary Preferred Brand	2	1	000011011001000001000		Formulary Preferred Brand				25	25		35	35			25						25					Formulary Preferred Brand																							2
H1036	011	0	1	01	01	H1036_011_0	4	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	011	0	1	01	01	H1036_011_0	4	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	011	0	1	01	01	H1036_011_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1036	011	0	1	01	01	H1036_011_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	025	0	1	01	01	H1036_025_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	025	0	1	01	01	H1036_025_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	025	0	1	01	01	H1036_025_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	40.00	120.00								40.00			40.00	100.00									4
H1036	025	0	1	01	01	H1036_025_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	034	0	1	01	01	H1036_034_0	3	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	034	0	1	01	01	H1036_034_0	3	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H1036	034	0	1	01	01	H1036_034_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	034	0	1	01	01	H1036_034_0	3	3	1	Other - Non-Preferred	001100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H1036	035	0	1	01	01	H1036_035_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	035	0	1	01	01	H1036_035_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H1036	035	0	1	01	01	H1036_035_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1036	035	0	1	01	01	H1036_035_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	037	0	1	01	01	H1036_037_0	3	1	1	Other - Pref Gen & Sel Brand	011001	1	2	Other - Pref Gen & Sel Brand	011000000010011000000	30	90								30			30	90								Other - Pref Gen & Sel Brand	2	2		011000000010011000000	Other - Pref Gen & Sel Brand																						Other - Pref Gen & Sel Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	037	0	1	01	01	H1036_037_0	3	3	1	Other - Non-preferred	100100	1	2	Other - Non-preferred	011000000010011000000	30	90								30			30	90								Other - Non-preferred	2	2		011000000010011000000	Other - Non-preferred																						Other - Non-preferred	70.00	210.00								70.00			70.00	175.00									4
H1036	037	0	1	01	01	H1036_037_0	3	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	037	0	1	01	01	H1036_037_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	040	0	1	01	01	H1036_040_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	40.00	120.00								40.00			40.00	100.00									4
H1036	040	0	1	01	01	H1036_040_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	040	0	1	01	01	H1036_040_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	040	0	1	01	01	H1036_040_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	044	0	1	01	01	H1036_044_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	044	0	1	01	01	H1036_044_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	65.00	195.00								65.00			65.00	162.50									4
H1036	044	0	1	01	01	H1036_044_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H1036	044	0	1	01	01	H1036_044_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H1036	047	0	1	01	01	H1036_047_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	047	0	1	01	01	H1036_047_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	75.00	225.00								75.00			75.00	187.50									4
H1036	047	0	1	01	01	H1036_047_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H1036	047	0	1	01	01	H1036_047_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	052	0	1	01	01	H1036_052_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	40.00	120.00								40.00			40.00	100.00									4
H1036	052	0	1	01	01	H1036_052_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	052	0	1	01	01	H1036_052_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	052	0	1	01	01	H1036_052_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	054	0	1	01	01	H1036_054_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1036	054	0	1	01	01	H1036_054_0	3	2	3	Preferred Brand	010001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1036	054	0	1	01	01	H1036_054_0	3	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1036	054	0	1	01	01	H1036_054_0	3	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	054	0	1	01	01	H1036_054_0	3	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	054	0	1	01	01	H1036_054_0	3	1	3	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00								1	4
H1036	054	0	1	01	01	H1036_054_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	054	0	1	01	01	H1036_054_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	30.00	90.00								30.00			30.00	75.00									4
H1036	062	0	1	01	01	H1036_062_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1036	062	0	1	01	01	H1036_062_0	3	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00								1	4
H1036	062	0	1	01	01	H1036_062_0	3	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1036	062	0	1	01	01	H1036_062_0	3	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1036	062	0	1	01	01	H1036_062_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1036	062	0	1	01	01	H1036_062_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	062	0	1	01	01	H1036_062_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1036	062	0	1	01	01	H1036_062_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	065	0	1	01	01	H1036_065_0	4	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	065	0	1	01	01	H1036_065_0	4	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1036	065	0	1	01	01	H1036_065_0	4	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1036	065	0	1	01	01	H1036_065_0	4	2	3	Preferred Brand	010001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1036	065	0	1	01	01	H1036_065_0	4	1	3	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00								1	4
H1036	065	0	1	01	01	H1036_065_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	065	0	1	01	01	H1036_065_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H1036	065	0	1	01	01	H1036_065_0	4	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	50.00									4
H1036	067	0	1	01	01	H1036_067_0	5	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1036	067	0	1	01	01	H1036_067_0	5	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1036	067	0	1	01	01	H1036_067_0	5	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1036	067	0	1	01	01	H1036_067_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	067	0	1	01	01	H1036_067_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	30.00	90.00								30.00			30.00	75.00									4
H1036	067	0	1	01	01	H1036_067_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	067	0	1	01	01	H1036_067_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	067	0	1	01	01	H1036_067_0	5	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00								1	4
H1036	068	0	1	01	01	H1036_068_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	068	0	1	01	01	H1036_068_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1036	068	0	1	01	01	H1036_068_0	5	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1036	068	0	1	01	01	H1036_068_0	5	1	1	Other - Pref Gen & Sel Brand	011001	1	2	Other - Pref Gen & Sel Brand	011000000010011000000	30	90								30			30	90								Other - Pref Gen & Sel Brand	2	2		011000000010011000000	Other - Pref Gen & Sel Brand																						Other - Pref Gen & Sel Brand	5.00	15.00								5.00			5.00	12.50									4
H1036	074	0	1	01	01	H1036_074_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	074	0	1	01	01	H1036_074_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	074	0	1	01	01	H1036_074_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	30.00	90.00								30.00			30.00	75.00									4
H1036	074	0	1	01	01	H1036_074_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	077	0	1	01	01	H1036_077_0	4	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	077	0	1	01	01	H1036_077_0	4	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	077	0	1	01	01	H1036_077_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1036	077	0	1	01	01	H1036_077_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1036	081	0	1	01	01	H1036_081_0	5	1	1	Other - Pref Gen & Sel Brand	011001	1	2	Other - Pref Gen & Sel Brand	011000000010011000000	30	90								30			30	90								Other - Pref Gen & Sel Brand	2	2		011000000010011000000	Other - Pref Gen & Sel Brand																						Other - Pref Gen & Sel Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	081	0	1	01	01	H1036_081_0	5	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	081	0	1	01	01	H1036_081_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1036	081	0	1	01	01	H1036_081_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H1036	099	0	1	01	01	H1036_099_0	6	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	099	0	1	01	01	H1036_099_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1036	099	0	1	01	01	H1036_099_0	6	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	099	0	1	01	01	H1036_099_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	28									28			28									Specialty																							4
H1036	100	0	1	01	01	H1036_100_0	7	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	100	0	1	01	01	H1036_100_0	7	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	100	0	1	01	01	H1036_100_0	7	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1036	100	0	1	01	01	H1036_100_0	7	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	28									28			28									Specialty																							4
H1036	101	0	1	01	01	H1036_101_0	7	1	1	Other - Pref Gen & Sel Brand	011001	1	2	Other - Pref Gen & Sel Brand	011000000010011000000	30	90								30			30	90								Other - Pref Gen & Sel Brand	2	2		011000000010011000000	Other - Pref Gen & Sel Brand																						Other - Pref Gen & Sel Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	101	0	1	01	01	H1036_101_0	7	2	1	Preferred Brand	011000	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	101	0	1	01	01	H1036_101_0	7	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1036	101	0	1	01	01	H1036_101_0	7	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1036	102	0	1	01	01	H1036_102_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	102	0	1	01	01	H1036_102_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	102	0	1	01	01	H1036_102_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	28									28			28									Specialty																							4
H1036	102	0	1	01	01	H1036_102_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1036	103	0	1	01	01	H1036_103_0	4	1	1	Other - Preferred Generic & Select Brand	011001	1	2	Other - Preferred Generic & Select Brand	011000000010011000000	30	90								30			30	90								Other - Preferred Generic & Select Brand	2	2		011000000010011000000	Other - Preferred Generic & Select Brand																						Other - Preferred Generic & Select Brand	0.00	0.00								0.00			0.00	0.00									4
H1036	103	0	1	01	01	H1036_103_0	4	2	1	Preferred Brand	010001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	103	0	1	01	01	H1036_103_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1036	103	0	1	01	01	H1036_103_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1036	104	0	1	01	01	H1036_104_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1036	104	0	1	01	01	H1036_104_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1036	104	0	1	01	01	H1036_104_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1036	104	0	1	01	01	H1036_104_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	28									28			28									Specialty																							4
H1045	001	0	1	05	01	H1045_001_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	25.00	75.00								25.00				50.00									4
H1045	001	0	1	05	01	H1045_001_0	3	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	10.00	30.00								10.00				20.00									4
H1045	001	0	1	05	01	H1045_001_0	3	4	3	IV/Injectables	010010	1	2	IV/Injectables																							IV/Injectables					IV/Injectables																						IV/Injectables																						2	4
H1045	001	0	1	05	01	H1045_001_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1045	001	0	1	05	01	H1045_001_0	3	2	3	Preferred Brand	000001	3	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1045	001	0	1	05	01	H1045_001_0	3	1	3	Generic	001001	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00								1	4
H1045	001	0	1	05	01	H1045_001_0	3	4	1	IV/Injectables	010010	1	2	IV/Injectables	011000000010000000000	30	90								30												IV/Injectables	1	1	011000000010000000000		IV/Injectables	20	20								20												IV/Injectables																							4
H1045	001	0	1	05	01	H1045_001_0	3	1	1	Generic	001001	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H1045	005	0	1	05	01	H1045_005_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	25.00	75.00								25.00				50.00									4
H1045	005	0	1	05	01	H1045_005_0	3	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	10.00	30.00								10.00				20.00									4
H1045	005	0	1	05	01	H1045_005_0	3	1	3	Generic	001001	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00								1	4
H1045	005	0	1	05	01	H1045_005_0	3	2	3	Preferred Brand	000001	3	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1045	005	0	1	05	01	H1045_005_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1045	005	0	1	05	01	H1045_005_0	3	4	3	IV/Injectables	010010	1	2	IV/Injectables																							IV/Injectables					IV/Injectables																						IV/Injectables																						2	4
H1045	005	0	1	05	01	H1045_005_0	3	1	1	Generic	001001	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H1045	005	0	1	05	01	H1045_005_0	3	4	1	IV/Injectables	010010	1	2	IV/Injectables	011000000010000000000	30	90								30												IV/Injectables	1	1	011000000010000000000		IV/Injectables	20	20								20												IV/Injectables																							4
H1045	008	0	1	05	01	H1045_008_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010000000000				30	90		30	90		30												Non-Preferred Brand	2	2		000011011010000000000	Non-Preferred Brand																						Non-Preferred Brand				0.00	0.00		10.00	30.00		10.00													4
H1045	008	0	1	05	01	H1045_008_0	4	2	1	Preferred Brand	000001	3	2	Preferred Brand	000011011010000000000				30	90		30	90		30												Preferred Brand	2	2		000011011010000000000	Preferred Brand																						Preferred Brand				0.00	0.00		10.00	30.00		10.00													4
H1045	008	0	1	05	01	H1045_008_0	4	1	1	Generic	001001	3	2	Generic	000011011010000000000				30	90		30	90		30												Generic	2	2		000011011010000000000	Generic																						Generic				0.00	0.00		5.00	15.00		5.00													4
H1045	008	0	1	05	01	H1045_008_0	4	4	3	IV/Injectables	010010	1	2	IV/Injectables																							IV/Injectables					IV/Injectables																						IV/Injectables																						2	4
H1045	008	0	1	05	01	H1045_008_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1045	008	0	1	05	01	H1045_008_0	4	4	1	IV/Injectables	010010	1	2	IV/Injectables	000011000010000000000				30	90					30												IV/Injectables	1	1	000011000010000000000		IV/Injectables				25	25					25												IV/Injectables																							4
H1045	008	0	1	05	01	H1045_008_0	4	1	3	Generic	001001	3	2	Generic	000011011010000000000				30	90		30	90		30												Generic	2	2		000011011010000000000	Generic																						Generic				0.00	0.00		5.00	15.00		5.00												1	4
H1045	008	0	1	05	01	H1045_008_0	4	2	3	Preferred Brand	000001	3	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1076	003	0	1	01	01	H1076_003_0	4	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				40.00			40.00			40.00													4
H1076	003	0	1	01	01	H1076_003_0	4	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				20.00	60.00	40.00	20.00			20.00			20.00	60.00	40.00								4
H1076	003	0	1	01	01	H1076_003_0	4	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1076	003	0	1	01	01	H1076_003_0	4	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H1076	003	0	1	01	01	H1076_003_0	4	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H1076	003	0	1	01	01	H1076_003_0	4	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H1076	003	0	1	01	01	H1076_003_0	4	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H1076	003	0	1	01	01	H1076_003_0	4	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1076	016	0	1	01	01	H1076_016_0	4	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				50.00			50.00			50.00													4
H1076	016	0	1	01	01	H1076_016_0	4	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				20.00	60.00	40.00	20.00			20.00			20.00	60.00	40.00								4
H1076	016	0	1	01	01	H1076_016_0	4	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1076	016	0	1	01	01	H1076_016_0	4	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H1076	016	0	1	01	01	H1076_016_0	4	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1076	016	0	1	01	01	H1076_016_0	4	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H1076	016	0	1	01	01	H1076_016_0	4	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H1076	016	0	1	01	01	H1076_016_0	4	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H1076	020	0	1	02	01	H1076_020_0	6	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1076	020	0	1	02	01	H1076_020_0	6	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				40.00	120.00	80.00	40.00			40.00			40.00	120.00	80.00								4
H1076	020	0	1	02	01	H1076_020_0	6	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				120.00			120.00			120.00													4
H1076	020	0	1	02	01	H1076_020_0	6	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H1076	022	0	1	02	01	H1076_022_0	6	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				120.00			120.00			120.00													4
H1076	022	0	1	02	01	H1076_022_0	6	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				40.00	120.00	80.00	40.00			40.00			40.00	120.00	80.00								4
H1076	022	0	1	02	01	H1076_022_0	6	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H1076	022	0	1	02	01	H1076_022_0	6	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H1080	004	0	1	01	01	H1080_004_0	11	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H1080	004	0	1	01	01	H1080_004_0	11	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H1080	004	0	1	01	01	H1080_004_0	11	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H1080	004	0	1	01	01	H1080_004_0	11	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1080	011	0	1	02	01	H1080_011_0	12	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H1080	011	0	1	02	01	H1080_011_0	12	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H1080	011	0	1	02	01	H1080_011_0	12	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1080	011	0	1	02	01	H1080_011_0	12	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H1080	036	0	1	01	01	H1080_036_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H1080	036	0	1	01	01	H1080_036_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H1080	036	0	1	01	01	H1080_036_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H1080	036	0	1	01	01	H1080_036_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1099	001	0	1	01	01	H1099_001_0	5	3	1	Tier 3	000010	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	35.00	105.00								35.00				70.00									4
H1099	001	0	1	01	01	H1099_001_0	5	2	1	Tier 2	010000	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	5.00	15.00								5.00				10.00									4
H1099	001	0	1	01	01	H1099_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	2.00	6.00								2.00				10.00									4
H1099	001	0	1	01	01	H1099_001_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	33	33								33				33								Tier 4																							4
H1099	006	0	1	01	01	H1099_006_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	2.00	6.00								2.00				10.00								1	4
H1099	006	0	1	01	01	H1099_006_0	5	2	3	Tier 2	010000	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1099	006	0	1	01	01	H1099_006_0	5	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1099	006	0	1	01	01	H1099_006_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	33	33								33				33								Tier 4																							4
H1099	006	0	1	01	01	H1099_006_0	5	3	1	Tier 3	000010	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	35.00	105.00								35.00				70.00									4
H1099	006	0	1	01	01	H1099_006_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1099	006	0	1	01	01	H1099_006_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	2.00	6.00								2.00				10.00									4
H1099	006	0	1	01	01	H1099_006_0	5	2	1	Tier 2	010000	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	5.00	15.00								5.00				10.00									4
H1108	001	0	1	04	01	H1108_001_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1108	001	0	1	04	01	H1108_001_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H1108	001	0	1	04	01	H1108_001_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H1108	001	0	1	04	01	H1108_001_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H1108	002	0	1	04	01	H1108_002_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H1108	002	0	1	04	01	H1108_002_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1108	002	0	1	04	01	H1108_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H1108	002	0	1	04	01	H1108_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H1108	006	0	1	04	01	H1108_006_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H1108	006	0	1	04	01	H1108_006_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1108	006	0	1	04	01	H1108_006_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H1108	006	0	1	04	01	H1108_006_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H1109	001	0	1	01	01	H1109_001_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H1109	001	0	1	01	01	H1109_001_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H1109	001	0	1	01	01	H1109_001_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H1109	002	0	1	01	01	H1109_002_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H1109	002	0	1	01	01	H1109_002_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H1109	002	0	1	01	01	H1109_002_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H1109	002	0	1	01	01	H1109_002_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H1109	002	0	1	01	01	H1109_002_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H1109	002	0	1	01	01	H1109_002_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H1109	002	0	1	01	01	H1109_002_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H1109	002	0	1	01	01	H1109_002_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H1109	003	0	1	01	01	H1109_003_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H1109	003	0	1	01	01	H1109_003_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H1109	003	0	1	01	01	H1109_003_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H1109	003	0	1	01	01	H1109_003_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H1109	003	0	1	01	01	H1109_003_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H1109	003	0	1	01	01	H1109_003_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H1109	003	0	1	01	01	H1109_003_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H1109	003	0	1	01	01	H1109_003_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H1110	001	0	1	04	01	H1110_001_0	6	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H1110	001	0	1	04	01	H1110_001_0	6	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H1110	001	0	1	04	01	H1110_001_0	6	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H1111	002	0	1	02	01	H1111_002_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H1111	002	0	1	02	01	H1111_002_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H1111	002	0	1	02	01	H1111_002_0	8	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H1111	002	0	1	02	01	H1111_002_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1111	004	0	1	01	01	H1111_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H1111	004	0	1	01	01	H1111_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H1111	004	0	1	01	01	H1111_004_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H1111	004	0	1	01	01	H1111_004_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1112	001	0	1	01	01	H1112_001_0	8	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1112	001	0	1	01	01	H1112_001_0	8	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1112	001	0	1	01	01	H1112_001_0	8	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1112	001	0	1	01	01	H1112_001_0	8	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1112	001	0	1	01	01	H1112_001_0	8	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1112	001	0	1	01	01	H1112_001_0	8	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H1112	001	0	1	01	01	H1112_001_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1112	001	0	1	01	01	H1112_001_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1112	011	0	1	01	01	H1112_011_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1112	011	0	1	01	01	H1112_011_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1112	011	0	1	01	01	H1112_011_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1112	011	0	1	01	01	H1112_011_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1170	002	0	1	01	01	H1170_002_0	4	2	1	Formulary Brand	000010		2	Formulary Brand	000011010010011000000				30	90		30			30			30	90								Formulary Brand	2	2		000011010010011000000	Formulary Brand																						Formulary Brand				30.00	90.00		50.00			50.00			20.00	60.00									3
H1170	002	0	1	01	01	H1170_002_0	4	1	1	Formulary Generic	010000		2	Formulary Generic	000011010010011000000				30	90		30			30			30	90								Formulary Generic	2	2		000011010010011000000	Formulary Generic																						Formulary Generic				14.00	42.00		24.00			24.00			10.00	30.00									3
H1170	008	0	1	01	01	H1170_008_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	000011010010011000000				30	90		30			30			30	90								Formulary Generic	2	2		000011010010011000000	Formulary Generic																						Formulary Generic				14.00	42.00		24.00			24.00			10.00	30.00									3
H1170	008	0	1	01	01	H1170_008_0	5	2	1	Formulary Brand	000010		2	Formulary Brand	000011010010011000000				30	90		30			30			30	90								Formulary Brand	2	2		000011010010011000000	Formulary Brand																						Formulary Brand				32.00	96.00		52.00			52.00			20.00	60.00									3
H1230	001	0	1	01	01	H1230_001_0	8	1	1	Generic	010000		2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	10.00	30.00								10.00	30.00		10.00	20.00									3
H1230	001	0	1	01	01	H1230_001_0	8	2	1	Brand	000010		2	Brand	011000000011011000000	30	90								30	90		30	90								Brand	2	2		011000000011011000000	Brand																						Brand	40.00	120.00								40.00	120.00		40.00	80.00									3
H1251	003	0	1	18	06	H1251_003_0	7	5	1	Tier 5 - Specialty	010010		1	Tier 5 - Specialty	011000000011000000000	30	90								30	90											Tier 5 - Specialty	2	1	011000000011000000000		Tier 5 - Specialty	25	25								25	25											Tier 5 - Specialty																							2
H1251	003	0	1	18	06	H1251_003_0	7	4	1	Tier 4 - Injectables	010010		2	Tier 4 - Injectables	011000000011000000000	30	90								30	90											Tier 4 - Injectables	2	1	011000000011000000000		Tier 4 - Injectables	25	25								25	25											Tier 4 - Injectables																							2
H1251	003	0	1	18	06	H1251_003_0	7	3	1	Tier 3 - Other Brand	100000		2	Tier 3 - Other Brand	011000000011001000000	30	90								30	90			90								Tier 3 - Other Brand	2	2		011000000011001000000	Tier 3 - Other Brand																						Tier 3 - Other Brand	50.00	150.00								50.00	150.00			120.00									2
H1251	003	0	1	18	06	H1251_003_0	7	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	011000000011001000000	30	90								30	90			90								Tier 2 - Preferred Brand	2	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	20.00	60.00								20.00	60.00			50.00									2
H1251	003	0	1	18	06	H1251_003_0	7	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	011000000011001000000	30	90								30	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	3.00	9.00								3.00	9.00			5.00									2
H1251	004	0	1	18	06	H1251_004_0	8	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	011000000011001000000	30	90								30	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	3.00	9.00								3.00	9.00			5.00									2
H1251	004	0	1	18	06	H1251_004_0	8	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	011000000011001000000	30	90								30	90			90								Tier 2 - Preferred Brand	2	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	20.00	60.00								20.00	60.00			50.00									2
H1251	004	0	1	18	06	H1251_004_0	8	3	1	Tier 3 - Other Brand	100000		2	Tier 3 - Other Brand	011000000011001000000	30	90								30	90			90								Tier 3 - Other Brand	2	2		011000000011001000000	Tier 3 - Other Brand																						Tier 3 - Other Brand	50.00	150.00								50.00	150.00			120.00									2
H1251	004	0	1	18	06	H1251_004_0	8	5	1	Tier 5 - Specialty	010010		1	Tier 5 - Specialty	011000000011000000000	30	90								30	90											Tier 5 - Specialty	2	1	011000000011000000000		Tier 5 - Specialty	25	25								25	25											Tier 5 - Specialty																							2
H1251	004	0	1	18	06	H1251_004_0	8	4	1	Tier 4 - Injectables	010010		2	Tier 4 - Injectables	011000000011000000000	30	90								30	90											Tier 4 - Injectables	2	1	011000000011000000000		Tier 4 - Injectables	25	25								25	25											Tier 4 - Injectables																							2
H1251	007	0	1	18	06	H1251_007_0	6	2	1	Tier 2 - Preferred Brand	000001	1	2	Tier 2 - Preferred Brand	011000000011001000000	30	90								30	90			90								Tier 2 - Preferred Brand	2	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	20.00	60.00								20.00	60.00			50.00									4
H1251	007	0	1	18	06	H1251_007_0	6	4	1	Tier 4 - Injectables	010010	1	2	Tier 4 - Injectables	011000000011000000000	30	90								30	90											Tier 4 - Injectables	2	1	011000000011000000000		Tier 4 - Injectables	25	25								25	25											Tier 4 - Injectables																							4
H1251	007	0	1	18	06	H1251_007_0	6	5	1	Tier 5 - Specialty	010010	1	1	Tier 5 - Specialty	011000000011000000000	30	90								30	90											Tier 5 - Specialty	2	1	011000000011000000000		Tier 5 - Specialty	25	25								25	25											Tier 5 - Specialty																							4
H1251	007	0	1	18	06	H1251_007_0	6	1	1	Tier 1 - Generic	010000	1	2	Tier 1 - Generic	011000000011001000000	30	90								30	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	2.00	6.00								2.00	6.00			5.00									4
H1251	007	0	1	18	06	H1251_007_0	6	3	1	Tier 3 - Other Brand	100000	1	2	Tier 3 - Other Brand	011000000011001000000	30	90								30	90			90								Tier 3 - Other Brand	2	2		011000000011001000000	Tier 3 - Other Brand																						Tier 3 - Other Brand	50.00	150.00								50.00	150.00			120.00									4
H1251	008	0	1	18	06	H1251_008_0	6	5	1	Tier 5 - Specialty	010010	1	1	Tier 5 - Specialty	011000000011000000000	30	90								30	90											Tier 5 - Specialty	2	1	011000000011000000000		Tier 5 - Specialty	25	25								25	25											Tier 5 - Specialty																							4
H1251	008	0	1	18	06	H1251_008_0	6	4	1	Tier 4 - Injectables	010010	1	2	Tier 4 - Injectables	011000000011000000000	30	90								30	90											Tier 4 - Injectables	2	1	011000000011000000000		Tier 4 - Injectables	25	25								25	25											Tier 4 - Injectables																							4
H1251	008	0	1	18	06	H1251_008_0	6	3	1	Tier 3 - Other Brand	100000	1	2	Tier 3 - Other Brand	011000000011001000000	30	90								30	90			90								Tier 3 - Other Brand	2	2		011000000011001000000	Tier 3 - Other Brand																						Tier 3 - Other Brand	50.00	150.00								50.00	150.00			120.00									4
H1251	008	0	1	18	06	H1251_008_0	6	2	1	Tier 2 - Preferred Brand	000001	1	2	Tier 2 - Preferred Brand	011000000011001000000	30	90								30	90			90								Tier 2 - Preferred Brand	2	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	20.00	60.00								20.00	60.00			50.00									4
H1251	008	0	1	18	06	H1251_008_0	6	1	1	Tier 1 - Generic	010000	1	2	Tier 1 - Generic	011000000011001000000	30	90								30	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	2.00	6.00								2.00	6.00			5.00									4
H1286	001	0	1	02	01	H1286_001_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H1286	001	0	1	02	01	H1286_001_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H1286	001	0	1	02	01	H1286_001_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H1286	001	0	1	02	01	H1286_001_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H1286	002	0	1	02	01	H1286_002_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1286	002	0	1	02	01	H1286_002_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H1286	002	0	1	02	01	H1286_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H1286	002	0	1	02	01	H1286_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H1286	004	0	1	02	01	H1286_004_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H1286	004	0	1	02	01	H1286_004_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H1286	004	0	1	02	01	H1286_004_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H1286	004	0	1	02	01	H1286_004_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1302	001	0	1	04	01	H1302_001_0	4	5	1	Specialty Drugs	110001		1	Specialty Drugs	011000000011011000000	30	90								30	90		30	90								Specialty Drugs	2	1	011000000011011000000		Specialty Drugs	25	25								25	25		25	25								Specialty Drugs																							2
H1302	001	0	1	04	01	H1302_001_0	4	4	1	Injectable Drugs	110001		1	Injectable Drugs	011000000011011000000	30	90								30	90		30	90								Injectable Drugs	2	1	011000000011011000000		Injectable Drugs	25	25								25	25		25	25								Injectable Drugs																							2
H1302	001	0	1	04	01	H1302_001_0	4	3	1	Non-Prefered Brand	100000		2	Non-Prefered Brand	011000000011011000000	30	90								30	90		30	90								Non-Prefered Brand	2	2		011000000011011000000	Non-Prefered Brand																						Non-Prefered Brand	35.00	105.00								35.00	105.00		35.00	105.00									2
H1302	001	0	1	04	01	H1302_001_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00		20.00	60.00									2
H1302	001	0	1	04	01	H1302_001_0	4	1	1	Generic	010000		2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	6.00	18.00								6.00	18.00		6.00	18.00									2
H1302	002	0	1	04	01	H1302_002_0	3	4	1	Injectable Drugs	110001		1	Injectable Drugs	011000000011011000000	30	90								30	90		30	90								Injectable Drugs	2	1	011000000011011000000		Injectable Drugs	25	25								25	25		25	25								Injectable Drugs																							2
H1302	002	0	1	04	01	H1302_002_0	3	5	1	Specialty Drugs	110001		1	Specialty Drugs	011000000011011000000	30	90								30	90		30	90								Specialty Drugs	2	1	011000000011011000000		Specialty Drugs	25	25								25	25		25	25								Specialty Drugs																							2
H1302	002	0	1	04	01	H1302_002_0	3	3	1	Non-Prefered Brand	100000		2	Non-Prefered Brand	011000000011011000000	30	90								30	90		30	90								Non-Prefered Brand	2	2		011000000011011000000	Non-Prefered Brand																						Non-Prefered Brand	35.00	105.00								35.00	105.00		35.00	105.00									2
H1302	002	0	1	04	01	H1302_002_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00		20.00	60.00									2
H1302	002	0	1	04	01	H1302_002_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	6.00	18.00								6.00	18.00		6.00	18.00									2
H1303	001	0	1	04	01	H1303_001_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H1303	001	0	1	04	01	H1303_001_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H1303	001	0	1	04	01	H1303_001_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H1303	001	0	1	04	01	H1303_001_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1303	004	0	1	04	01	H1303_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H1303	004	0	1	04	01	H1303_004_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1303	004	0	1	04	01	H1303_004_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H1303	004	0	1	04	01	H1303_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H1304	002	0	1	04	01	H1304_002_0	3	5	1	Miscellaneous Injectable	110001		2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							2
H1304	002	0	1	04	01	H1304_002_0	3	1	1	Generic	010000		2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									2
H1304	002	0	1	04	01	H1304_002_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				18.00	54.00		18.00			18.00			54.00	54.00									2
H1304	002	0	1	04	01	H1304_002_0	3	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	105.00		35.00			35.00			105.00	105.00									2
H1304	002	0	1	04	01	H1304_002_0	3	4	1	Specialty	110001		1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							2
H1304	004	0	1	04	01	H1304_004_0	3	1	1	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									4
H1304	004	0	1	04	01	H1304_004_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00			25.00			75.00	75.00									4
H1304	004	0	1	04	01	H1304_004_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	150.00		50.00			50.00			150.00	150.00									4
H1304	004	0	1	04	01	H1304_004_0	3	4	1	Specialty Medications	110001	1	1	Specialty Medications	000010010010010000000				30			30			30			30									Specialty Medications	2	1	000010010010010000000		Specialty Medications				25			25			25			25									Specialty Medications																							4
H1304	004	0	1	04	01	H1304_004_0	3	5	3	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables																							Miscellaneous Injectables					Miscellaneous Injectables																						Miscellaneous Injectables																						2	4
H1304	004	0	1	04	01	H1304_004_0	3	1	3	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00								1	4
H1304	004	0	1	04	01	H1304_004_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1304	004	0	1	04	01	H1304_004_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1304	004	0	1	04	01	H1304_004_0	3	4	3	Specialty Medications	110001	1	1	Specialty Medications																							Specialty Medications					Specialty Medications																						Specialty Medications																						2	4
H1304	004	0	1	04	01	H1304_004_0	3	5	1	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables	000010010010010000000				30			30			30			30									Miscellaneous Injectables	2	1	000010010010010000000		Miscellaneous Injectables				25			25			25			25									Miscellaneous Injectables																							4
H1340	006	0	1	09	04	H1340_006_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	006	0	1	09	04	H1340_006_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	006	0	1	09	04	H1340_006_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	006	0	1	09	04	H1340_006_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	007	0	1	09	04	H1340_007_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	007	0	1	09	04	H1340_007_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	007	0	1	09	04	H1340_007_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	007	0	1	09	04	H1340_007_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	008	0	1	09	04	H1340_008_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	008	0	1	09	04	H1340_008_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	008	0	1	09	04	H1340_008_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	008	0	1	09	04	H1340_008_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	009	0	1	09	04	H1340_009_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	009	0	1	09	04	H1340_009_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	009	0	1	09	04	H1340_009_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	009	0	1	09	04	H1340_009_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	010	0	1	09	04	H1340_010_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	010	0	1	09	04	H1340_010_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	010	0	1	09	04	H1340_010_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	010	0	1	09	04	H1340_010_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	011	0	1	09	04	H1340_011_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	011	0	1	09	04	H1340_011_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	011	0	1	09	04	H1340_011_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	011	0	1	09	04	H1340_011_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	012	0	1	09	04	H1340_012_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	64.00	192.00								64.00	192.00			192.00									4
H1340	012	0	1	09	04	H1340_012_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	54.00	162.00								54.00	162.00			162.00									4
H1340	012	0	1	09	04	H1340_012_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	012	0	1	09	04	H1340_012_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	013	0	1	09	04	H1340_013_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	013	0	1	09	04	H1340_013_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	013	0	1	09	04	H1340_013_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	013	0	1	09	04	H1340_013_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	014	0	1	09	04	H1340_014_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	014	0	1	09	04	H1340_014_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	014	0	1	09	04	H1340_014_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	014	0	1	09	04	H1340_014_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	015	0	1	09	04	H1340_015_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	015	0	1	09	04	H1340_015_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	015	0	1	09	04	H1340_015_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	015	0	1	09	04	H1340_015_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	016	0	1	09	04	H1340_016_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	016	0	1	09	04	H1340_016_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	016	0	1	09	04	H1340_016_0	4	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1340	016	0	1	09	04	H1340_016_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	017	0	1	09	04	H1340_017_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1340	017	0	1	09	04	H1340_017_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H1340	017	0	1	09	04	H1340_017_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H1340	017	0	1	09	04	H1340_017_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1350	001	0	1	01	01	H1350_001_0	4	1	1	Tier 1 - Generic	010000	1	2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	6.00	18.00								6.00	18.00		6.00	18.00									4
H1350	001	0	1	01	01	H1350_001_0	4	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 2 Preferred Brand	2	2		011000000011011000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	20.00	60.00								20.00	60.00		20.00	60.00									4
H1350	001	0	1	01	01	H1350_001_0	4	5	3	Specialty Drugs	110001	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1350	001	0	1	01	01	H1350_001_0	4	4	3	Injectable Drugs	110001	1	1	Injectable Drugs																							Injectable Drugs					Injectable Drugs																						Injectable Drugs																						2	4
H1350	001	0	1	01	01	H1350_001_0	4	3	3	Tier 3 - Non Preferred Brand	100000	1	2	Tier 3 - Non Preferred Brand																							Tier 3 - Non Preferred Brand					Tier 3 - Non Preferred Brand																						Tier 3 - Non Preferred Brand																						2	4
H1350	001	0	1	01	01	H1350_001_0	4	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H1350	001	0	1	01	01	H1350_001_0	4	3	1	Tier 3 - Non Preferred Brand	100000	1	2	Tier 3 - Non Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 3 - Non Preferred Brand	2	2		011000000011011000000	Tier 3 - Non Preferred Brand																						Tier 3 - Non Preferred Brand	35.00	105.00								35.00	105.00		35.00	105.00									4
H1350	001	0	1	01	01	H1350_001_0	4	4	1	Injectable Drugs	110001	1	1	Injectable Drugs	011000000011011000000	30	90								30	90		30	90								Injectable Drugs	2	1	011000000011011000000		Injectable Drugs	25	25								25	25		25	25								Injectable Drugs																							4
H1350	001	0	1	01	01	H1350_001_0	4	5	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011011000000	30	90								30	90		30	90								Specialty Drugs	2	1	011000000011011000000		Specialty Drugs	25	25								25	25		25	25								Specialty Drugs																							4
H1350	001	0	1	01	01	H1350_001_0	4	1	3	Tier 1 - Generic	010000	1	2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	6.00	18.00								6.00	18.00		6.00	18.00								1	4
H1350	002	0	1	01	01	H1350_002_0	4	4	1	Injectable Drugs	110001	1	1	Injectable Drugs	011000000011011000000	30	90								30	90		30	90								Injectable Drugs	2	1	011000000011011000000		Injectable Drugs	25	25								25	25		25	25								Injectable Drugs																							4
H1350	002	0	1	01	01	H1350_002_0	4	3	1	Tier 3 - Non Preferred Brand	100000	1	2	Tier 3 - Non Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 3 - Non Preferred Brand	2	2		011000000011011000000	Tier 3 - Non Preferred Brand																						Tier 3 - Non Preferred Brand	35.00	105.00								35.00	105.00		35.00	105.00									4
H1350	002	0	1	01	01	H1350_002_0	4	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 2 Preferred Brand	2	2		011000000011011000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	20.00	60.00								20.00	60.00		20.00	60.00									4
H1350	002	0	1	01	01	H1350_002_0	4	1	1	Tier 1 - Generic	010000	1	2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	6.00	18.00								6.00	18.00		6.00	18.00									4
H1350	002	0	1	01	01	H1350_002_0	4	5	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011011000000	30	90								30	90		30	90								Specialty Drugs	2	1	011000000011011000000		Specialty Drugs	25	25								25	25		25	25								Specialty Drugs																							4
H1406	006	0	1	01	01	H1406_006_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H1406	006	0	1	01	01	H1406_006_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	62.50									4
H1406	006	0	1	01	01	H1406_006_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1406	006	0	1	01	01	H1406_006_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	55.00	165.00								55.00			55.00	137.50									4
H1406	013	0	1	01	01	H1406_013_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	62.50									4
H1406	013	0	1	01	01	H1406_013_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1406	013	0	1	01	01	H1406_013_0	5	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	55.00	165.00								55.00			55.00	137.50									4
H1406	013	0	1	01	01	H1406_013_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H1406	014	0	1	01	01	H1406_014_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	62.50									4
H1406	014	0	1	01	01	H1406_014_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H1406	014	0	1	01	01	H1406_014_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	55.00	165.00								55.00			55.00	137.50									4
H1406	014	0	1	01	01	H1406_014_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1406	022	0	1	01	01	H1406_022_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H1406	022	0	1	01	01	H1406_022_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	62.50									4
H1406	022	0	1	01	01	H1406_022_0	5	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	55.00	165.00								55.00			55.00	137.50									4
H1406	022	0	1	01	01	H1406_022_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1406	024	0	1	01	01	H1406_024_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H1406	024	0	1	01	01	H1406_024_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H1406	024	0	1	01	01	H1406_024_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	28									28			28									Specialty																							4
H1406	024	0	1	01	01	H1406_024_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1407	001	0	1	09	04	H1407_001_0	7	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1407	001	0	1	09	04	H1407_001_0	7	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1407	001	0	1	09	04	H1407_001_0	7	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1407	001	0	1	09	04	H1407_001_0	7	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1407	003	0	1	09	04	H1407_003_0	7	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1407	003	0	1	09	04	H1407_003_0	7	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1407	003	0	1	09	04	H1407_003_0	7	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1407	003	0	1	09	04	H1407_003_0	7	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1415	004	0	1	01	01	H1415_004_0	3	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H1415	004	0	1	01	01	H1415_004_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H1415	004	0	1	01	01	H1415_004_0	3	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1415	004	0	1	01	01	H1415_004_0	3	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H1415	004	0	1	01	01	H1415_004_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1415	004	0	1	01	01	H1415_004_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H1415	004	0	1	01	01	H1415_004_0	3	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H1415	004	0	1	01	01	H1415_004_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H1415	008	0	1	01	01	H1415_008_0	3	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1415	008	0	1	01	01	H1415_008_0	3	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H1415	008	0	1	01	01	H1415_008_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1415	008	0	1	01	01	H1415_008_0	3	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H1415	008	0	1	01	01	H1415_008_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H1415	008	0	1	01	01	H1415_008_0	3	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H1415	008	0	1	01	01	H1415_008_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H1415	008	0	1	01	01	H1415_008_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H1415	010	0	1	01	01	H1415_010_0	3	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H1415	010	0	1	01	01	H1415_010_0	3	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H1415	010	0	1	01	01	H1415_010_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1415	010	0	1	01	01	H1415_010_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H1415	010	0	1	01	01	H1415_010_0	3	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1415	010	0	1	01	01	H1415_010_0	3	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H1415	010	0	1	01	01	H1415_010_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H1415	010	0	1	01	01	H1415_010_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H1416	001	0	1	01	01	H1416_001_0	7	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1416	001	0	1	01	01	H1416_001_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1416	001	0	1	01	01	H1416_001_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1416	001	0	1	01	01	H1416_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1416	001	0	1	01	01	H1416_001_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1416	001	0	1	01	01	H1416_001_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1416	001	0	1	01	01	H1416_001_0	7	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1416	001	0	1	01	01	H1416_001_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1416	002	0	1	01	01	H1416_002_0	7	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1416	002	0	1	01	01	H1416_002_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1416	002	0	1	01	01	H1416_002_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1416	002	0	1	01	01	H1416_002_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1416	002	0	1	01	01	H1416_002_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1416	002	0	1	01	01	H1416_002_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1416	002	0	1	01	01	H1416_002_0	7	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1416	002	0	1	01	01	H1416_002_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1416	009	0	1	01	01	H1416_009_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1416	009	0	1	01	01	H1416_009_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1416	009	0	1	01	01	H1416_009_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1416	009	0	1	01	01	H1416_009_0	6	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1417	002	0	1	04	01	H1417_002_0	5	4	1	Specialty	010010		1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							3
H1417	002	0	1	04	01	H1417_002_0	5	3	1	Tier 3	100000		2	Tier 3	011000000010011000000	30	90								30			30	90								Tier 3	2	2		011000000010011000000	Tier 3																						Tier 3	52.00	104.00								52.00			52.00	104.00									3
H1417	002	0	1	04	01	H1417_002_0	5	1	1	Tier 1	010000		2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00									3
H1417	002	0	1	04	01	H1417_002_0	5	2	1	Tier 2	000001		2	Tier 2	011000000010011000000	30	90								30			30	90								Tier 2	2	2		011000000010011000000	Tier 2																						Tier 2	34.00	68.00								34.00			34.00	68.00									3
H1417	004	0	1	04	01	H1417_004_0	5	1	1	Tier 1	010000		2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00									3
H1417	004	0	1	04	01	H1417_004_0	5	2	1	Tier 2	000001		2	Tier 2	011000000010011000000	30	90								30			30	90								Tier 2	2	2		011000000010011000000	Tier 2																						Tier 2	34.00	68.00								34.00			34.00	68.00									3
H1417	004	0	1	04	01	H1417_004_0	5	3	1	Tier 3	100000		2	Tier 3	011000000010011000000	30	90								30			30	90								Tier 3	2	2		011000000010011000000	Tier 3																						Tier 3	52.00	104.00								52.00			52.00	104.00									3
H1417	004	0	1	04	01	H1417_004_0	5	4	1	Specialty	010010		1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							3
H1417	005	0	1	04	01	H1417_005_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00									4
H1417	005	0	1	04	01	H1417_005_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010011000000	30	90								30			30	90								Tier 2	2	2		011000000010011000000	Tier 2																						Tier 2	34.00	68.00								34.00			34.00	68.00									4
H1417	005	0	1	04	01	H1417_005_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000010011000000	30	90								30			30	90								Tier 3	2	2		011000000010011000000	Tier 3																						Tier 3	52.00	104.00								52.00			52.00	104.00									4
H1417	005	0	1	04	01	H1417_005_0	5	4	1	Specialty	010010	1	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							4
H1417	005	0	1	04	01	H1417_005_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00								1	4
H1417	005	0	1	04	01	H1417_005_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1417	005	0	1	04	01	H1417_005_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1417	005	0	1	04	01	H1417_005_0	5	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1417	006	0	1	04	01	H1417_006_0	5	4	1	Specialty	010010	1	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							4
H1417	006	0	1	04	01	H1417_006_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00								1	4
H1417	006	0	1	04	01	H1417_006_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1417	006	0	1	04	01	H1417_006_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010011000000	30	90								30			30	90								Tier 2	2	2		011000000010011000000	Tier 2																						Tier 2	34.00	68.00								34.00			34.00	68.00									4
H1417	006	0	1	04	01	H1417_006_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00									4
H1417	006	0	1	04	01	H1417_006_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000010011000000	30	90								30			30	90								Tier 3	2	2		011000000010011000000	Tier 3																						Tier 3	52.00	104.00								52.00			52.00	104.00									4
H1417	006	0	1	04	01	H1417_006_0	5	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1417	006	0	1	04	01	H1417_006_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1418	002	0	1	04	01	H1418_002_0	6	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1418	002	0	1	04	01	H1418_002_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	55.00	165.00								55.00			55.00	137.50									4
H1418	002	0	1	04	01	H1418_002_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1418	002	0	1	04	01	H1418_002_0	6	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H1419	001	0	1	01	01	H1419_001_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H1419	001	0	1	01	01	H1419_001_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H1419	001	0	1	01	01	H1419_001_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H1419	002	0	1	01	01	H1419_002_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H1419	002	0	1	01	01	H1419_002_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H1419	002	0	1	01	01	H1419_002_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H1419	002	0	1	01	01	H1419_002_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H1419	002	0	1	01	01	H1419_002_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H1419	002	0	1	01	01	H1419_002_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H1419	002	0	1	01	01	H1419_002_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H1419	002	0	1	01	01	H1419_002_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H1419	003	0	1	01	01	H1419_003_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H1419	003	0	1	01	01	H1419_003_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H1419	003	0	1	01	01	H1419_003_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H1419	003	0	1	01	01	H1419_003_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H1419	003	0	1	01	01	H1419_003_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H1419	003	0	1	01	01	H1419_003_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H1419	003	0	1	01	01	H1419_003_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H1419	003	0	1	01	01	H1419_003_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H1419	004	0	1	01	01	H1419_004_0	5	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H1419	004	0	1	01	01	H1419_004_0	5	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H1419	004	0	1	01	01	H1419_004_0	5	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H1420	001	0	1	04	01	H1420_001_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H1420	001	0	1	04	01	H1420_001_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H1420	001	0	1	04	01	H1420_001_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H1420	002	0	1	04	01	H1420_002_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H1420	002	0	1	04	01	H1420_002_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H1420	002	0	1	04	01	H1420_002_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H1420	002	0	1	04	01	H1420_002_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H1420	002	0	1	04	01	H1420_002_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H1420	002	0	1	04	01	H1420_002_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H1420	002	0	1	04	01	H1420_002_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H1420	002	0	1	04	01	H1420_002_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H1463	003	0	1	01	01	H1463_003_0	4	3	1	Tier 3	100000		2	Tier 3	011000000010011000000	30	90								30			30	90								Tier 3	2	2		011000000010011000000	Tier 3																						Tier 3	52.00	104.00								52.00			52.00	104.00									3
H1463	003	0	1	01	01	H1463_003_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010011000000	30	90								30			30	90								Tier 2	2	2		011000000010011000000	Tier 2																						Tier 2	34.00	68.00								34.00			34.00	68.00									3
H1463	003	0	1	01	01	H1463_003_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00									3
H1463	003	0	1	01	01	H1463_003_0	4	4	1	Specialty	010010		1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							3
H1463	004	0	1	01	01	H1463_004_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00									3
H1463	004	0	1	01	01	H1463_004_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010011000000	30	90								30			30	90								Tier 2	2	2		011000000010011000000	Tier 2																						Tier 2	34.00	68.00								34.00			34.00	68.00									3
H1463	004	0	1	01	01	H1463_004_0	4	3	1	Tier 3	100000		2	Tier 3	011000000010011000000	30	90								30			30	90								Tier 3	2	2		011000000010011000000	Tier 3																						Tier 3	52.00	104.00								52.00			52.00	104.00									3
H1463	004	0	1	01	01	H1463_004_0	4	4	1	Specialty	010010		1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							3
H1463	005	0	1	01	01	H1463_005_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00									4
H1463	005	0	1	01	01	H1463_005_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010011000000	30	90								30			30	90								Tier 2	2	2		011000000010011000000	Tier 2																						Tier 2	34.00	68.00								34.00			34.00	68.00									4
H1463	005	0	1	01	01	H1463_005_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000010011000000	30	90								30			30	90								Tier 3	2	2		011000000010011000000	Tier 3																						Tier 3	52.00	104.00								52.00			52.00	104.00									4
H1463	005	0	1	01	01	H1463_005_0	4	4	1	Specialty	010010	1	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							4
H1463	005	0	1	01	01	H1463_005_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00								1	4
H1463	005	0	1	01	01	H1463_005_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1463	005	0	1	01	01	H1463_005_0	4	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1463	005	0	1	01	01	H1463_005_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1463	006	0	1	01	01	H1463_006_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1463	006	0	1	01	01	H1463_006_0	4	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1463	006	0	1	01	01	H1463_006_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1463	006	0	1	01	01	H1463_006_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00								1	4
H1463	006	0	1	01	01	H1463_006_0	4	4	1	Specialty	010010	1	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							4
H1463	006	0	1	01	01	H1463_006_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000010011000000	30	90								30			30	90								Tier 3	2	2		011000000010011000000	Tier 3																						Tier 3	52.00	104.00								52.00			52.00	104.00									4
H1463	006	0	1	01	01	H1463_006_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010011000000	30	90								30			30	90								Tier 2	2	2		011000000010011000000	Tier 2																						Tier 2	34.00	68.00								34.00			34.00	68.00									4
H1463	006	0	1	01	01	H1463_006_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010011000000	30	90								30			30	90								Tier 1	2	2		011000000010011000000	Tier 1																						Tier 1	4.00	8.00								4.00			4.00	8.00									4
H1468	004	0	1	01	01	H1468_004_0	2	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010011000000	30	90								10			30	90								Formulary Specialty	2	1	011000000010011000000		Formulary Specialty	30	30								30			30	30								Formulary Specialty																							4
H1468	004	0	1	01	01	H1468_004_0	2	3	1	Formulary Non - Preferred	100100	1	2	Formulary Non - Preferred	011000000010011000000	30	90								10			30	90								Formulary Non - Preferred	2	1	011000000010011000000		Formulary Non - Preferred	50	50								50			50	50								Formulary Non - Preferred																							4
H1468	004	0	1	01	01	H1468_004_0	2	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010011000000	30	90								10			30	90								Formulary Preferred Brand	2	2		011000000010011000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	60.00								30.00			30.00	60.00									4
H1468	004	0	1	01	01	H1468_004_0	2	1	1	Formulary Preferred Generic	001000	1	2	Formulary Preferred Generic	011000000010011000000	30	90								10			30	90								Formulary Preferred Generic	2	2		011000000010011000000	Formulary Preferred Generic																						Formulary Preferred Generic	8.00	16.00								8.00			8.00	16.00									4
H1468	004	0	1	01	01	H1468_004_0	2	1	3	Formulary Preferred Generic	001000	1	2	Formulary Preferred Generic	011000000010011000000	30	90								10			30	90								Formulary Preferred Generic	2	2		011000000010011000000	Formulary Preferred Generic																						Formulary Preferred Generic	8.00	16.00								8.00			8.00	16.00								1	4
H1468	004	0	1	01	01	H1468_004_0	2	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010011000000	30	90								10			30	90								Formulary Preferred Brand	2	1	011000000010011000000		Formulary Preferred Brand	50	50								50			50	50								Formulary Preferred Brand																						1	4
H1468	004	0	1	01	01	H1468_004_0	2	4	3	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010011000000	30	90								10			30	90								Formulary Specialty	2	1	011000000010011000000		Formulary Specialty	50	50								50			50	50								Formulary Specialty																						1	4
H1468	004	0	1	01	01	H1468_004_0	2	3	3	Formulary Non - Preferred	100100	1	2	Formulary Non - Preferred	011000000010011000000	30	90								10			30	90								Formulary Non - Preferred	2	1	011000000010011000000		Formulary Non - Preferred	50	50								50			50	50								Formulary Non - Preferred																						1	4
H1468	006	0	1	01	01	H1468_006_0	2	1	1	Formulary Preferred Generic	001000	1	2	Formulary Preferred Generic	011000000010011000000	30	90								10			30	90								Formulary Preferred Generic	2	2		011000000010011000000	Formulary Preferred Generic																						Formulary Preferred Generic	8.00	16.00								8.00			8.00	16.00									4
H1468	006	0	1	01	01	H1468_006_0	2	3	1	Formulary Non - Preferred	100100	1	2	Formulary Non - Preferred	011000000010011000000	30	90								10			30	90								Formulary Non - Preferred	2	1	011000000010011000000		Formulary Non - Preferred	50	50								50			50	50								Formulary Non - Preferred																							4
H1468	006	0	1	01	01	H1468_006_0	2	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010011000000	30	90								10			30	90								Formulary Preferred Brand	2	2		011000000010011000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	60.00								30.00			30.00	60.00									4
H1468	006	0	1	01	01	H1468_006_0	2	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010011000000	30	90								10			30	90								Formulary Specialty	2	1	011000000010011000000		Formulary Specialty	30	30								30			30	30								Formulary Specialty																							4
H1468	007	0	1	01	01	H1468_007_0	4	1	1	Preferred Generic Formulary	001000		2	Preferred Generic Formulary	011000000000111000000	30	90										10	30	90								Preferred Generic Formulary	2	2		011000000000111000000	Preferred Generic Formulary																						Preferred Generic Formulary	8.00	16.00										8.00	8.00	16.00									3
H1468	007	0	1	01	01	H1468_007_0	4	2	1	Preferred Brand Formulary	000001		2	Preferred Brand Formulary	011000000000111000000	30	90										10	30	90								Preferred Brand Formulary	2	2		011000000000111000000	Preferred Brand Formulary																						Preferred Brand Formulary	32.00	64.00										32.00	32.00	64.00									3
H1468	007	0	1	01	01	H1468_007_0	4	3	1	Non Preferred Formulary	100100		2	Non Preferred Formulary	011000000000111000000	30	90										10	30	90								Non Preferred Formulary	2	2		011000000000111000000	Non Preferred Formulary																						Non Preferred Formulary	48.00	96.00										48.00	48.00	96.00									3
H1468	007	0	1	01	01	H1468_007_0	4	4	1	Specialty Formulary	010010		1	Specialty Formulary	011000000000111000000	30	90										10	30	90								Specialty Formulary	2	2		011000000000111000000	Specialty Formulary																						Specialty Formulary	48.00	96.00										48.00	48.00	96.00									3
H1509	001	0	1	04	01	H1509_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H1509	001	0	1	04	01	H1509_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1509	001	0	1	04	01	H1509_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H1509	001	0	1	04	01	H1509_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H1509	004	0	1	04	01	H1509_004_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H1509	004	0	1	04	01	H1509_004_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1509	004	0	1	04	01	H1509_004_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H1509	004	0	1	04	01	H1509_004_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H1510	001	0	1	04	01	H1510_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1510	001	0	1	04	01	H1510_001_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H1510	001	0	1	04	01	H1510_001_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H1510	001	0	1	04	01	H1510_001_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1511	001	0	1	01	01	H1511_001_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1511	001	0	1	01	01	H1511_001_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1511	001	0	1	01	01	H1511_001_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H1511	001	0	1	01	01	H1511_001_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H1511	001	0	1	01	01	H1511_001_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H1511	001	0	1	01	01	H1511_001_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H1511	001	0	1	01	01	H1511_001_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1511	001	0	1	01	01	H1511_001_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1511	001	0	1	01	01	H1511_001_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00		1	4
H1511	001	0	1	01	01	H1511_001_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1511	005	0	1	01	01	H1511_005_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H1511	005	0	1	01	01	H1511_005_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1511	005	0	1	01	01	H1511_005_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1511	005	0	1	01	01	H1511_005_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H1511	005	0	1	01	01	H1511_005_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H1511	005	0	1	01	01	H1511_005_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1511	005	0	1	01	01	H1511_005_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00		1	4
H1511	005	0	1	01	01	H1511_005_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1511	005	0	1	01	01	H1511_005_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H1511	005	0	1	01	01	H1511_005_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1607	001	0	1	04	01	H1607_001_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H1607	001	0	1	04	01	H1607_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1607	001	0	1	04	01	H1607_001_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1607	001	0	1	04	01	H1607_001_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H1607	001	0	1	04	01	H1607_001_0	6	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H1607	001	0	1	04	01	H1607_001_0	6	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00		1	4
H1607	001	0	1	04	01	H1607_001_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1607	001	0	1	04	01	H1607_001_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1607	001	0	1	04	01	H1607_001_0	6	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H1607	001	0	1	04	01	H1607_001_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1607	002	0	1	04	01	H1607_002_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00			4
H1607	002	0	1	04	01	H1607_002_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			4
H1607	002	0	1	04	01	H1607_002_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1607	002	0	1	04	01	H1607_002_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H1607	002	0	1	04	01	H1607_002_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1607	002	0	1	04	01	H1607_002_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00		1	4
H1607	002	0	1	04	01	H1607_002_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1607	002	0	1	04	01	H1607_002_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1607	002	0	1	04	01	H1607_002_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H1607	002	0	1	04	01	H1607_002_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H1608	001	0	1	04	01	H1608_001_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	78.00								26.00				52.00									4
H1608	001	0	1	04	01	H1608_001_0	7	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	64.00	192.00								64.00				128.00									4
H1608	001	0	1	04	01	H1608_001_0	7	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H1608	001	0	1	04	01	H1608_001_0	7	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H1608	001	0	1	04	01	H1608_001_0	7	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H1608	001	0	1	04	01	H1608_001_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1608	001	0	1	04	01	H1608_001_0	7	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H1608	001	0	1	04	01	H1608_001_0	7	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1609	001	0	1	01	01	H1609_001_0	8	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	64.00	192.00								64.00				128.00									4
H1609	001	0	1	01	01	H1609_001_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	78.00								26.00				52.00									4
H1609	001	0	1	01	01	H1609_001_0	8	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H1609	001	0	1	01	01	H1609_001_0	8	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H1609	001	0	1	01	01	H1609_001_0	8	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1609	001	0	1	01	01	H1609_001_0	8	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H1609	001	0	1	01	01	H1609_001_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1609	001	0	1	01	01	H1609_001_0	8	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H1609	003	0	1	01	01	H1609_003_0	8	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H1609	003	0	1	01	01	H1609_003_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	78.00								26.00				52.00									4
H1609	003	0	1	01	01	H1609_003_0	8	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	64.00	192.00								64.00				128.00									4
H1609	003	0	1	01	01	H1609_003_0	8	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H1609	003	0	1	01	01	H1609_003_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1609	003	0	1	01	01	H1609_003_0	8	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H1609	003	0	1	01	01	H1609_003_0	8	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H1609	003	0	1	01	01	H1609_003_0	8	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H1689	002	0	1	09	04	H1689_002_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1689	002	0	1	09	04	H1689_002_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1689	002	0	1	09	04	H1689_002_0	6	4	1	Non-Speciality Injectables	010010	1	2	Non-Speciality Injectables	011000000010000001001	30	90								30							90			90		Non-Speciality Injectables	2	1	011000000010000001001		Non-Speciality Injectables	30	30								30							25			25		Non-Speciality Injectables																							4
H1689	002	0	1	09	04	H1689_002_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H1689	002	0	1	09	04	H1689_002_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1689	004	0	1	09	04	H1689_004_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1689	004	0	1	09	04	H1689_004_0	7	4	1	Non-Speciality Injectables	010010	1	2	Non-Speciality Injectables	011000000010000001001	30	90								30							90			90		Non-Speciality Injectables	2	1	011000000010000001001		Non-Speciality Injectables	30	30								30							25			25		Non-Speciality Injectables																							4
H1689	004	0	1	09	04	H1689_004_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1689	004	0	1	09	04	H1689_004_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1689	004	0	1	09	04	H1689_004_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H1689	006	0	1	09	04	H1689_006_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1689	006	0	1	09	04	H1689_006_0	7	4	1	Non-Speciality Injectables	010010	1	2	Non-Speciality Injectables	011000000010000001001	30	90								30							90			90		Non-Speciality Injectables	2	1	011000000010000001001		Non-Speciality Injectables	30	30								30							25			25		Non-Speciality Injectables																							4
H1689	006	0	1	09	04	H1689_006_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1689	006	0	1	09	04	H1689_006_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H1689	006	0	1	09	04	H1689_006_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1689	010	0	1	09	04	H1689_010_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1689	010	0	1	09	04	H1689_010_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H1689	010	0	1	09	04	H1689_010_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1689	010	0	1	09	04	H1689_010_0	7	4	1	Non-Speciality Injectables	010010	1	2	Non-Speciality Injectables	011000000010000001001	30	90								30							90			90		Non-Speciality Injectables	2	1	011000000010000001001		Non-Speciality Injectables	30	30								30							25			25		Non-Speciality Injectables																							4
H1689	010	0	1	09	04	H1689_010_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1689	013	0	1	09	04	H1689_013_0	8	4	1	Non-Speciality Injectables	010010	1	2	Non-Speciality Injectables	011000000010000001001	30	90								30							90			90		Non-Speciality Injectables	2	1	011000000010000001001		Non-Speciality Injectables	30	30								30							25			25		Non-Speciality Injectables																							4
H1689	013	0	1	09	04	H1689_013_0	8	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H1689	013	0	1	09	04	H1689_013_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1689	013	0	1	09	04	H1689_013_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1689	013	0	1	09	04	H1689_013_0	8	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1689	015	0	1	09	04	H1689_015_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H1689	015	0	1	09	04	H1689_015_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1689	015	0	1	09	04	H1689_015_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1689	015	0	1	09	04	H1689_015_0	7	4	1	Non-Speciality Injectables	010010	1	2	Non-Speciality Injectables	011000000010000001001	30	90								30							90			90		Non-Speciality Injectables	2	1	011000000010000001001		Non-Speciality Injectables	30	30								30							25			25		Non-Speciality Injectables																							4
H1689	015	0	1	09	04	H1689_015_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1716	001	0	1	04	01	H1716_001_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	55.00	165.00								55.00			55.00	137.50									4
H1716	001	0	1	04	01	H1716_001_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H1716	001	0	1	04	01	H1716_001_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H1716	001	0	1	04	01	H1716_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1717	001	0	1	04	01	H1717_001_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1717	001	0	1	04	01	H1717_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H1717	001	0	1	04	01	H1717_001_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H1717	001	0	1	04	01	H1717_001_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H1717	006	0	1	04	01	H1717_006_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H1717	006	0	1	04	01	H1717_006_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H1717	006	0	1	04	01	H1717_006_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H1717	006	0	1	04	01	H1717_006_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H1804	001	0	1	09	04	H1804_001_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	001	0	1	09	04	H1804_001_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	001	0	1	09	04	H1804_001_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	001	0	1	09	04	H1804_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	005	0	1	09	04	H1804_005_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	005	0	1	09	04	H1804_005_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	005	0	1	09	04	H1804_005_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	005	0	1	09	04	H1804_005_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	006	0	1	09	04	H1804_006_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	006	0	1	09	04	H1804_006_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	006	0	1	09	04	H1804_006_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	006	0	1	09	04	H1804_006_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	007	0	1	09	04	H1804_007_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	007	0	1	09	04	H1804_007_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	007	0	1	09	04	H1804_007_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	007	0	1	09	04	H1804_007_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	008	0	1	09	04	H1804_008_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	008	0	1	09	04	H1804_008_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	008	0	1	09	04	H1804_008_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	008	0	1	09	04	H1804_008_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	009	0	1	09	04	H1804_009_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	009	0	1	09	04	H1804_009_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	009	0	1	09	04	H1804_009_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	009	0	1	09	04	H1804_009_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	011	0	1	09	04	H1804_011_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	011	0	1	09	04	H1804_011_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	011	0	1	09	04	H1804_011_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	011	0	1	09	04	H1804_011_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	013	0	1	09	04	H1804_013_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	013	0	1	09	04	H1804_013_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	013	0	1	09	04	H1804_013_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	013	0	1	09	04	H1804_013_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	014	0	1	09	04	H1804_014_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	014	0	1	09	04	H1804_014_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	014	0	1	09	04	H1804_014_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	014	0	1	09	04	H1804_014_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	016	0	1	09	04	H1804_016_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	016	0	1	09	04	H1804_016_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	016	0	1	09	04	H1804_016_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	016	0	1	09	04	H1804_016_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	018	0	1	09	04	H1804_018_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	018	0	1	09	04	H1804_018_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	018	0	1	09	04	H1804_018_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	018	0	1	09	04	H1804_018_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	019	0	1	09	04	H1804_019_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	019	0	1	09	04	H1804_019_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	019	0	1	09	04	H1804_019_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	019	0	1	09	04	H1804_019_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	020	0	1	09	04	H1804_020_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	020	0	1	09	04	H1804_020_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	020	0	1	09	04	H1804_020_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	020	0	1	09	04	H1804_020_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	022	0	1	09	04	H1804_022_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	022	0	1	09	04	H1804_022_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	022	0	1	09	04	H1804_022_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	022	0	1	09	04	H1804_022_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	023	0	1	09	04	H1804_023_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	023	0	1	09	04	H1804_023_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	023	0	1	09	04	H1804_023_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	023	0	1	09	04	H1804_023_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	025	0	1	09	04	H1804_025_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	025	0	1	09	04	H1804_025_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	025	0	1	09	04	H1804_025_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	025	0	1	09	04	H1804_025_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	061	0	1	09	04	H1804_061_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	061	0	1	09	04	H1804_061_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	061	0	1	09	04	H1804_061_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	061	0	1	09	04	H1804_061_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	063	0	1	09	04	H1804_063_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	063	0	1	09	04	H1804_063_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	063	0	1	09	04	H1804_063_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	063	0	1	09	04	H1804_063_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	066	0	1	09	04	H1804_066_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	066	0	1	09	04	H1804_066_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	066	0	1	09	04	H1804_066_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	066	0	1	09	04	H1804_066_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	067	0	1	09	04	H1804_067_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	067	0	1	09	04	H1804_067_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	067	0	1	09	04	H1804_067_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	067	0	1	09	04	H1804_067_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	068	0	1	09	04	H1804_068_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	068	0	1	09	04	H1804_068_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	068	0	1	09	04	H1804_068_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	068	0	1	09	04	H1804_068_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	070	0	1	09	04	H1804_070_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	070	0	1	09	04	H1804_070_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	070	0	1	09	04	H1804_070_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	070	0	1	09	04	H1804_070_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	075	0	1	09	04	H1804_075_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	075	0	1	09	04	H1804_075_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	075	0	1	09	04	H1804_075_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	075	0	1	09	04	H1804_075_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	077	0	1	09	04	H1804_077_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	077	0	1	09	04	H1804_077_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	077	0	1	09	04	H1804_077_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	077	0	1	09	04	H1804_077_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	078	0	1	09	04	H1804_078_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	078	0	1	09	04	H1804_078_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	078	0	1	09	04	H1804_078_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	078	0	1	09	04	H1804_078_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	081	0	1	09	04	H1804_081_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	081	0	1	09	04	H1804_081_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	081	0	1	09	04	H1804_081_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	081	0	1	09	04	H1804_081_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	083	0	1	09	04	H1804_083_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	083	0	1	09	04	H1804_083_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	083	0	1	09	04	H1804_083_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	083	0	1	09	04	H1804_083_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	086	0	1	09	04	H1804_086_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	086	0	1	09	04	H1804_086_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	086	0	1	09	04	H1804_086_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	086	0	1	09	04	H1804_086_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	087	0	1	09	04	H1804_087_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	087	0	1	09	04	H1804_087_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	087	0	1	09	04	H1804_087_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	087	0	1	09	04	H1804_087_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	088	0	1	09	04	H1804_088_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	088	0	1	09	04	H1804_088_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	088	0	1	09	04	H1804_088_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	088	0	1	09	04	H1804_088_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	089	0	1	09	04	H1804_089_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	089	0	1	09	04	H1804_089_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	089	0	1	09	04	H1804_089_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	089	0	1	09	04	H1804_089_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	090	0	1	09	04	H1804_090_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	090	0	1	09	04	H1804_090_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	090	0	1	09	04	H1804_090_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	090	0	1	09	04	H1804_090_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	091	0	1	09	04	H1804_091_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	091	0	1	09	04	H1804_091_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	091	0	1	09	04	H1804_091_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	091	0	1	09	04	H1804_091_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	093	0	1	09	04	H1804_093_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	093	0	1	09	04	H1804_093_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	093	0	1	09	04	H1804_093_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	093	0	1	09	04	H1804_093_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	094	0	1	09	04	H1804_094_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	094	0	1	09	04	H1804_094_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	094	0	1	09	04	H1804_094_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	094	0	1	09	04	H1804_094_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	095	0	1	09	04	H1804_095_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	095	0	1	09	04	H1804_095_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	095	0	1	09	04	H1804_095_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	095	0	1	09	04	H1804_095_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	097	0	1	09	04	H1804_097_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	097	0	1	09	04	H1804_097_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	097	0	1	09	04	H1804_097_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	097	0	1	09	04	H1804_097_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	098	0	1	09	04	H1804_098_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	098	0	1	09	04	H1804_098_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	098	0	1	09	04	H1804_098_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	098	0	1	09	04	H1804_098_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	099	0	1	09	04	H1804_099_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	099	0	1	09	04	H1804_099_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	099	0	1	09	04	H1804_099_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	099	0	1	09	04	H1804_099_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	103	0	1	09	04	H1804_103_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	103	0	1	09	04	H1804_103_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	103	0	1	09	04	H1804_103_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	103	0	1	09	04	H1804_103_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	122	0	1	09	04	H1804_122_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	122	0	1	09	04	H1804_122_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	122	0	1	09	04	H1804_122_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	122	0	1	09	04	H1804_122_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	123	0	1	09	04	H1804_123_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	123	0	1	09	04	H1804_123_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	123	0	1	09	04	H1804_123_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	123	0	1	09	04	H1804_123_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	125	0	1	09	04	H1804_125_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	125	0	1	09	04	H1804_125_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	125	0	1	09	04	H1804_125_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	125	0	1	09	04	H1804_125_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	126	0	1	09	04	H1804_126_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	126	0	1	09	04	H1804_126_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	126	0	1	09	04	H1804_126_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	126	0	1	09	04	H1804_126_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	127	0	1	09	04	H1804_127_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	127	0	1	09	04	H1804_127_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	127	0	1	09	04	H1804_127_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	127	0	1	09	04	H1804_127_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	128	0	1	09	04	H1804_128_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	128	0	1	09	04	H1804_128_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	128	0	1	09	04	H1804_128_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	128	0	1	09	04	H1804_128_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	129	0	1	09	04	H1804_129_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	129	0	1	09	04	H1804_129_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	129	0	1	09	04	H1804_129_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	129	0	1	09	04	H1804_129_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	130	0	1	09	04	H1804_130_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	130	0	1	09	04	H1804_130_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	130	0	1	09	04	H1804_130_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	130	0	1	09	04	H1804_130_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	131	0	1	09	04	H1804_131_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	131	0	1	09	04	H1804_131_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	131	0	1	09	04	H1804_131_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	131	0	1	09	04	H1804_131_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	132	0	1	09	04	H1804_132_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	132	0	1	09	04	H1804_132_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	132	0	1	09	04	H1804_132_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	132	0	1	09	04	H1804_132_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	133	0	1	09	04	H1804_133_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	133	0	1	09	04	H1804_133_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	133	0	1	09	04	H1804_133_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	133	0	1	09	04	H1804_133_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	137	0	1	09	04	H1804_137_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	137	0	1	09	04	H1804_137_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	137	0	1	09	04	H1804_137_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	137	0	1	09	04	H1804_137_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	138	0	1	09	04	H1804_138_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	138	0	1	09	04	H1804_138_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	138	0	1	09	04	H1804_138_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	138	0	1	09	04	H1804_138_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	143	0	1	09	04	H1804_143_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	143	0	1	09	04	H1804_143_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	143	0	1	09	04	H1804_143_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	143	0	1	09	04	H1804_143_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	144	0	1	09	04	H1804_144_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	144	0	1	09	04	H1804_144_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	144	0	1	09	04	H1804_144_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	144	0	1	09	04	H1804_144_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	145	0	1	09	04	H1804_145_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	145	0	1	09	04	H1804_145_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	145	0	1	09	04	H1804_145_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	145	0	1	09	04	H1804_145_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	146	0	1	09	04	H1804_146_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	146	0	1	09	04	H1804_146_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	146	0	1	09	04	H1804_146_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	146	0	1	09	04	H1804_146_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	147	0	1	09	04	H1804_147_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	147	0	1	09	04	H1804_147_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	147	0	1	09	04	H1804_147_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	147	0	1	09	04	H1804_147_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	153	0	1	09	04	H1804_153_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	153	0	1	09	04	H1804_153_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	153	0	1	09	04	H1804_153_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	153	0	1	09	04	H1804_153_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	154	0	1	09	04	H1804_154_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	154	0	1	09	04	H1804_154_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	154	0	1	09	04	H1804_154_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	154	0	1	09	04	H1804_154_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	155	0	1	09	04	H1804_155_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	155	0	1	09	04	H1804_155_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	155	0	1	09	04	H1804_155_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	155	0	1	09	04	H1804_155_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	156	0	1	09	04	H1804_156_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	156	0	1	09	04	H1804_156_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	156	0	1	09	04	H1804_156_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	156	0	1	09	04	H1804_156_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	157	0	1	09	04	H1804_157_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	157	0	1	09	04	H1804_157_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	157	0	1	09	04	H1804_157_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	157	0	1	09	04	H1804_157_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	158	0	1	09	04	H1804_158_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	158	0	1	09	04	H1804_158_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	158	0	1	09	04	H1804_158_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	158	0	1	09	04	H1804_158_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	159	0	1	09	04	H1804_159_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	159	0	1	09	04	H1804_159_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	159	0	1	09	04	H1804_159_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	159	0	1	09	04	H1804_159_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	160	0	1	09	04	H1804_160_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	160	0	1	09	04	H1804_160_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	160	0	1	09	04	H1804_160_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	160	0	1	09	04	H1804_160_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	161	0	1	09	04	H1804_161_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	161	0	1	09	04	H1804_161_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	161	0	1	09	04	H1804_161_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	161	0	1	09	04	H1804_161_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	162	0	1	09	04	H1804_162_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	162	0	1	09	04	H1804_162_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	162	0	1	09	04	H1804_162_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	162	0	1	09	04	H1804_162_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	163	0	1	09	04	H1804_163_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	163	0	1	09	04	H1804_163_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	163	0	1	09	04	H1804_163_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	163	0	1	09	04	H1804_163_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	164	0	1	09	04	H1804_164_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	164	0	1	09	04	H1804_164_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	164	0	1	09	04	H1804_164_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	164	0	1	09	04	H1804_164_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	165	0	1	09	04	H1804_165_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	165	0	1	09	04	H1804_165_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	165	0	1	09	04	H1804_165_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	165	0	1	09	04	H1804_165_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	166	0	1	09	04	H1804_166_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	166	0	1	09	04	H1804_166_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	166	0	1	09	04	H1804_166_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	166	0	1	09	04	H1804_166_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	167	0	1	09	04	H1804_167_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	167	0	1	09	04	H1804_167_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	167	0	1	09	04	H1804_167_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	167	0	1	09	04	H1804_167_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	168	0	1	09	04	H1804_168_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	168	0	1	09	04	H1804_168_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	168	0	1	09	04	H1804_168_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	168	0	1	09	04	H1804_168_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	169	0	1	09	04	H1804_169_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	169	0	1	09	04	H1804_169_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	169	0	1	09	04	H1804_169_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	169	0	1	09	04	H1804_169_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	170	0	1	09	04	H1804_170_0	7	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	170	0	1	09	04	H1804_170_0	7	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	170	0	1	09	04	H1804_170_0	7	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	170	0	1	09	04	H1804_170_0	7	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	171	0	1	09	04	H1804_171_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	171	0	1	09	04	H1804_171_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	171	0	1	09	04	H1804_171_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	171	0	1	09	04	H1804_171_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	172	0	1	09	04	H1804_172_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	172	0	1	09	04	H1804_172_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	172	0	1	09	04	H1804_172_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	172	0	1	09	04	H1804_172_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	173	0	1	09	04	H1804_173_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	173	0	1	09	04	H1804_173_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	173	0	1	09	04	H1804_173_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	173	0	1	09	04	H1804_173_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	174	0	1	09	04	H1804_174_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	174	0	1	09	04	H1804_174_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	174	0	1	09	04	H1804_174_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	174	0	1	09	04	H1804_174_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	175	0	1	09	04	H1804_175_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	175	0	1	09	04	H1804_175_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	175	0	1	09	04	H1804_175_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	175	0	1	09	04	H1804_175_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	176	0	1	09	04	H1804_176_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	176	0	1	09	04	H1804_176_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	176	0	1	09	04	H1804_176_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	176	0	1	09	04	H1804_176_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	177	0	1	09	04	H1804_177_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	177	0	1	09	04	H1804_177_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	177	0	1	09	04	H1804_177_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	177	0	1	09	04	H1804_177_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	178	0	1	09	04	H1804_178_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	178	0	1	09	04	H1804_178_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	178	0	1	09	04	H1804_178_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	178	0	1	09	04	H1804_178_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	180	0	1	09	04	H1804_180_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	180	0	1	09	04	H1804_180_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	180	0	1	09	04	H1804_180_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	180	0	1	09	04	H1804_180_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	181	0	1	09	04	H1804_181_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	181	0	1	09	04	H1804_181_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	181	0	1	09	04	H1804_181_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	181	0	1	09	04	H1804_181_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	184	0	1	09	04	H1804_184_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	184	0	1	09	04	H1804_184_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	184	0	1	09	04	H1804_184_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	184	0	1	09	04	H1804_184_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	185	0	1	09	04	H1804_185_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	185	0	1	09	04	H1804_185_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	185	0	1	09	04	H1804_185_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	185	0	1	09	04	H1804_185_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	186	0	1	09	04	H1804_186_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	186	0	1	09	04	H1804_186_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	186	0	1	09	04	H1804_186_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	186	0	1	09	04	H1804_186_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	187	0	1	09	04	H1804_187_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	187	0	1	09	04	H1804_187_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	187	0	1	09	04	H1804_187_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	187	0	1	09	04	H1804_187_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	188	0	1	09	04	H1804_188_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	188	0	1	09	04	H1804_188_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	188	0	1	09	04	H1804_188_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	188	0	1	09	04	H1804_188_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	189	0	1	09	04	H1804_189_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	189	0	1	09	04	H1804_189_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	189	0	1	09	04	H1804_189_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	189	0	1	09	04	H1804_189_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	190	0	1	09	04	H1804_190_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	190	0	1	09	04	H1804_190_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	190	0	1	09	04	H1804_190_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	190	0	1	09	04	H1804_190_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	191	0	1	09	04	H1804_191_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	191	0	1	09	04	H1804_191_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	191	0	1	09	04	H1804_191_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	191	0	1	09	04	H1804_191_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	192	0	1	09	04	H1804_192_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	192	0	1	09	04	H1804_192_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	192	0	1	09	04	H1804_192_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	192	0	1	09	04	H1804_192_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	193	0	1	09	04	H1804_193_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	193	0	1	09	04	H1804_193_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	193	0	1	09	04	H1804_193_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	193	0	1	09	04	H1804_193_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	194	0	1	09	04	H1804_194_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	194	0	1	09	04	H1804_194_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	194	0	1	09	04	H1804_194_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	194	0	1	09	04	H1804_194_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	195	0	1	09	04	H1804_195_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	195	0	1	09	04	H1804_195_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	195	0	1	09	04	H1804_195_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	195	0	1	09	04	H1804_195_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	196	0	1	09	04	H1804_196_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	196	0	1	09	04	H1804_196_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	196	0	1	09	04	H1804_196_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	196	0	1	09	04	H1804_196_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	197	0	1	09	04	H1804_197_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	197	0	1	09	04	H1804_197_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	197	0	1	09	04	H1804_197_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	197	0	1	09	04	H1804_197_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	198	0	1	09	04	H1804_198_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	198	0	1	09	04	H1804_198_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	198	0	1	09	04	H1804_198_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	198	0	1	09	04	H1804_198_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	199	0	1	09	04	H1804_199_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	199	0	1	09	04	H1804_199_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	199	0	1	09	04	H1804_199_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	199	0	1	09	04	H1804_199_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	200	0	1	09	04	H1804_200_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	200	0	1	09	04	H1804_200_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	200	0	1	09	04	H1804_200_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	200	0	1	09	04	H1804_200_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	201	0	1	09	04	H1804_201_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	201	0	1	09	04	H1804_201_0	6	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	201	0	1	09	04	H1804_201_0	6	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	201	0	1	09	04	H1804_201_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	202	0	1	09	04	H1804_202_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	202	0	1	09	04	H1804_202_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	202	0	1	09	04	H1804_202_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	202	0	1	09	04	H1804_202_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	203	0	1	09	04	H1804_203_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	203	0	1	09	04	H1804_203_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	203	0	1	09	04	H1804_203_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	203	0	1	09	04	H1804_203_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	204	0	1	09	04	H1804_204_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	204	0	1	09	04	H1804_204_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	204	0	1	09	04	H1804_204_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	204	0	1	09	04	H1804_204_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	205	0	1	09	04	H1804_205_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	205	0	1	09	04	H1804_205_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	205	0	1	09	04	H1804_205_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	205	0	1	09	04	H1804_205_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	206	0	1	09	04	H1804_206_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	206	0	1	09	04	H1804_206_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	206	0	1	09	04	H1804_206_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	206	0	1	09	04	H1804_206_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	207	0	1	09	04	H1804_207_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	207	0	1	09	04	H1804_207_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	207	0	1	09	04	H1804_207_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	207	0	1	09	04	H1804_207_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	208	0	1	09	04	H1804_208_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	208	0	1	09	04	H1804_208_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	208	0	1	09	04	H1804_208_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	208	0	1	09	04	H1804_208_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	209	0	1	09	04	H1804_209_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	209	0	1	09	04	H1804_209_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	209	0	1	09	04	H1804_209_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	209	0	1	09	04	H1804_209_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	210	0	1	09	04	H1804_210_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	210	0	1	09	04	H1804_210_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	210	0	1	09	04	H1804_210_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	210	0	1	09	04	H1804_210_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	211	0	1	09	04	H1804_211_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	211	0	1	09	04	H1804_211_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	211	0	1	09	04	H1804_211_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	211	0	1	09	04	H1804_211_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	212	0	1	09	04	H1804_212_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	212	0	1	09	04	H1804_212_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	212	0	1	09	04	H1804_212_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	212	0	1	09	04	H1804_212_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	213	0	1	09	04	H1804_213_0	6	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	213	0	1	09	04	H1804_213_0	6	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	213	0	1	09	04	H1804_213_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	213	0	1	09	04	H1804_213_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	214	0	1	09	04	H1804_214_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	214	0	1	09	04	H1804_214_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	214	0	1	09	04	H1804_214_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	214	0	1	09	04	H1804_214_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	216	0	1	09	04	H1804_216_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	216	0	1	09	04	H1804_216_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	216	0	1	09	04	H1804_216_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	216	0	1	09	04	H1804_216_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	217	0	1	09	04	H1804_217_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	217	0	1	09	04	H1804_217_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	217	0	1	09	04	H1804_217_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	217	0	1	09	04	H1804_217_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	218	0	1	09	04	H1804_218_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	218	0	1	09	04	H1804_218_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	218	0	1	09	04	H1804_218_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	218	0	1	09	04	H1804_218_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	219	0	1	09	04	H1804_219_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	219	0	1	09	04	H1804_219_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	219	0	1	09	04	H1804_219_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	219	0	1	09	04	H1804_219_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	220	0	1	09	04	H1804_220_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	220	0	1	09	04	H1804_220_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	220	0	1	09	04	H1804_220_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	220	0	1	09	04	H1804_220_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	221	0	1	09	04	H1804_221_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	221	0	1	09	04	H1804_221_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	221	0	1	09	04	H1804_221_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	221	0	1	09	04	H1804_221_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	222	0	1	09	04	H1804_222_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	222	0	1	09	04	H1804_222_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	222	0	1	09	04	H1804_222_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	222	0	1	09	04	H1804_222_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	223	0	1	09	04	H1804_223_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	223	0	1	09	04	H1804_223_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	223	0	1	09	04	H1804_223_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	223	0	1	09	04	H1804_223_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	224	0	1	09	04	H1804_224_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	224	0	1	09	04	H1804_224_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	224	0	1	09	04	H1804_224_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	224	0	1	09	04	H1804_224_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	225	0	1	09	04	H1804_225_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	225	0	1	09	04	H1804_225_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	225	0	1	09	04	H1804_225_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	225	0	1	09	04	H1804_225_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	226	0	1	09	04	H1804_226_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	226	0	1	09	04	H1804_226_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	226	0	1	09	04	H1804_226_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	226	0	1	09	04	H1804_226_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	227	0	1	09	04	H1804_227_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	227	0	1	09	04	H1804_227_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	227	0	1	09	04	H1804_227_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	227	0	1	09	04	H1804_227_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	228	0	1	09	04	H1804_228_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	228	0	1	09	04	H1804_228_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	228	0	1	09	04	H1804_228_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	228	0	1	09	04	H1804_228_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	229	0	1	09	04	H1804_229_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	229	0	1	09	04	H1804_229_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	229	0	1	09	04	H1804_229_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	229	0	1	09	04	H1804_229_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	230	0	1	09	04	H1804_230_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	230	0	1	09	04	H1804_230_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	230	0	1	09	04	H1804_230_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	230	0	1	09	04	H1804_230_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	231	0	1	09	04	H1804_231_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	231	0	1	09	04	H1804_231_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	231	0	1	09	04	H1804_231_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	231	0	1	09	04	H1804_231_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	232	0	1	09	04	H1804_232_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	232	0	1	09	04	H1804_232_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	232	0	1	09	04	H1804_232_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	232	0	1	09	04	H1804_232_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	233	0	1	09	04	H1804_233_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	233	0	1	09	04	H1804_233_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	233	0	1	09	04	H1804_233_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	233	0	1	09	04	H1804_233_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	234	0	1	09	04	H1804_234_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	234	0	1	09	04	H1804_234_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	234	0	1	09	04	H1804_234_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	234	0	1	09	04	H1804_234_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	235	0	1	09	04	H1804_235_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	235	0	1	09	04	H1804_235_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	235	0	1	09	04	H1804_235_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	235	0	1	09	04	H1804_235_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	236	0	1	09	04	H1804_236_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	236	0	1	09	04	H1804_236_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	236	0	1	09	04	H1804_236_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	236	0	1	09	04	H1804_236_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	237	0	1	09	04	H1804_237_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	237	0	1	09	04	H1804_237_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	237	0	1	09	04	H1804_237_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	237	0	1	09	04	H1804_237_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	238	0	1	09	04	H1804_238_0	7	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	238	0	1	09	04	H1804_238_0	7	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	238	0	1	09	04	H1804_238_0	7	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	238	0	1	09	04	H1804_238_0	7	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	239	0	1	09	04	H1804_239_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	239	0	1	09	04	H1804_239_0	6	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	239	0	1	09	04	H1804_239_0	6	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	239	0	1	09	04	H1804_239_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	240	0	1	09	04	H1804_240_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	240	0	1	09	04	H1804_240_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	240	0	1	09	04	H1804_240_0	6	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	240	0	1	09	04	H1804_240_0	6	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	241	0	1	09	04	H1804_241_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	241	0	1	09	04	H1804_241_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	241	0	1	09	04	H1804_241_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	241	0	1	09	04	H1804_241_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	242	0	1	09	04	H1804_242_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	242	0	1	09	04	H1804_242_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	242	0	1	09	04	H1804_242_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	242	0	1	09	04	H1804_242_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	243	0	1	09	04	H1804_243_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	243	0	1	09	04	H1804_243_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	243	0	1	09	04	H1804_243_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	243	0	1	09	04	H1804_243_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	245	0	1	09	04	H1804_245_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	245	0	1	09	04	H1804_245_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	245	0	1	09	04	H1804_245_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	245	0	1	09	04	H1804_245_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	246	0	1	09	04	H1804_246_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	246	0	1	09	04	H1804_246_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	246	0	1	09	04	H1804_246_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	246	0	1	09	04	H1804_246_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	247	0	1	09	04	H1804_247_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	247	0	1	09	04	H1804_247_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	247	0	1	09	04	H1804_247_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	247	0	1	09	04	H1804_247_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	248	0	1	09	04	H1804_248_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	248	0	1	09	04	H1804_248_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	248	0	1	09	04	H1804_248_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	248	0	1	09	04	H1804_248_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	251	0	1	09	04	H1804_251_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	251	0	1	09	04	H1804_251_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	251	0	1	09	04	H1804_251_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	251	0	1	09	04	H1804_251_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	252	0	1	09	04	H1804_252_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	252	0	1	09	04	H1804_252_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	252	0	1	09	04	H1804_252_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	252	0	1	09	04	H1804_252_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	254	0	1	09	04	H1804_254_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	254	0	1	09	04	H1804_254_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	254	0	1	09	04	H1804_254_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	254	0	1	09	04	H1804_254_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	255	0	1	09	04	H1804_255_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	255	0	1	09	04	H1804_255_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	255	0	1	09	04	H1804_255_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	255	0	1	09	04	H1804_255_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	257	0	1	09	04	H1804_257_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	257	0	1	09	04	H1804_257_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	257	0	1	09	04	H1804_257_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	257	0	1	09	04	H1804_257_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	258	0	1	09	04	H1804_258_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	258	0	1	09	04	H1804_258_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	258	0	1	09	04	H1804_258_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	258	0	1	09	04	H1804_258_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	260	0	1	09	04	H1804_260_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	260	0	1	09	04	H1804_260_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	260	0	1	09	04	H1804_260_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	260	0	1	09	04	H1804_260_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	261	0	1	09	04	H1804_261_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	261	0	1	09	04	H1804_261_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	261	0	1	09	04	H1804_261_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	261	0	1	09	04	H1804_261_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	263	0	1	09	04	H1804_263_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	263	0	1	09	04	H1804_263_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	263	0	1	09	04	H1804_263_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	263	0	1	09	04	H1804_263_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	264	0	1	09	04	H1804_264_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	264	0	1	09	04	H1804_264_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	264	0	1	09	04	H1804_264_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	264	0	1	09	04	H1804_264_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	266	0	1	09	04	H1804_266_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	266	0	1	09	04	H1804_266_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	266	0	1	09	04	H1804_266_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	266	0	1	09	04	H1804_266_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	267	0	1	09	04	H1804_267_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	267	0	1	09	04	H1804_267_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	267	0	1	09	04	H1804_267_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	267	0	1	09	04	H1804_267_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	269	0	1	09	04	H1804_269_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	269	0	1	09	04	H1804_269_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	269	0	1	09	04	H1804_269_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	269	0	1	09	04	H1804_269_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	270	0	1	09	04	H1804_270_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	270	0	1	09	04	H1804_270_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	270	0	1	09	04	H1804_270_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	270	0	1	09	04	H1804_270_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	272	0	1	09	04	H1804_272_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	272	0	1	09	04	H1804_272_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	272	0	1	09	04	H1804_272_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	272	0	1	09	04	H1804_272_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	273	0	1	09	04	H1804_273_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	273	0	1	09	04	H1804_273_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	273	0	1	09	04	H1804_273_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	273	0	1	09	04	H1804_273_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	274	0	1	09	04	H1804_274_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	274	0	1	09	04	H1804_274_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1804	274	0	1	09	04	H1804_274_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	274	0	1	09	04	H1804_274_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	275	0	1	09	04	H1804_275_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1804	275	0	1	09	04	H1804_275_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1804	275	0	1	09	04	H1804_275_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1804	275	0	1	09	04	H1804_275_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1806	001	0	1	04	01	H1806_001_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H1806	001	0	1	04	01	H1806_001_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H1806	001	0	1	04	01	H1806_001_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1806	001	0	1	04	01	H1806_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1806	002	0	1	04	01	H1806_002_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H1806	002	0	1	04	01	H1806_002_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H1806	002	0	1	04	01	H1806_002_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H1806	002	0	1	04	01	H1806_002_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1849	005	0	1	01	01	H1849_005_0	8	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H1849	005	0	1	01	01	H1849_005_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1849	005	0	1	01	01	H1849_005_0	8	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H1849	005	0	1	01	01	H1849_005_0	8	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H1849	005	0	1	01	01	H1849_005_0	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1849	005	0	1	01	01	H1849_005_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1849	005	0	1	01	01	H1849_005_0	8	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00		1	4
H1849	005	0	1	01	01	H1849_005_0	8	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1849	005	0	1	01	01	H1849_005_0	8	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H1849	005	0	1	01	01	H1849_005_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1849	014	0	1	01	01	H1849_014_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H1849	014	0	1	01	01	H1849_014_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H1849	014	0	1	01	01	H1849_014_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H1849	014	0	1	01	01	H1849_014_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1849	014	0	1	01	01	H1849_014_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H1849	014	0	1	01	01	H1849_014_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H1849	014	0	1	01	01	H1849_014_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H1849	014	0	1	01	01	H1849_014_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H1849	014	0	1	01	01	H1849_014_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H1849	014	0	1	01	01	H1849_014_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00		1	4
H1850	002	0	1	09	04	H1850_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
H1850	002	0	1	09	04	H1850_002_0	6	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H1850	002	0	1	09	04	H1850_002_0	6	3	1	Tier 3	100000	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H1850	002	0	1	09	04	H1850_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H1903	001	0	1	01	01	H1903_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1903	001	0	1	01	01	H1903_001_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	60.00	180.00								60.00	180.00			180.00									4
H1903	001	0	1	01	01	H1903_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1903	001	0	1	01	01	H1903_001_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H1903	001	0	1	01	01	H1903_001_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H1903	001	0	1	01	01	H1903_001_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H1903	001	0	1	01	01	H1903_001_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H1903	001	0	1	01	01	H1903_001_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1903	018	0	1	01	01	H1903_018_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H1903	018	0	1	01	01	H1903_018_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H1903	018	0	1	01	01	H1903_018_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H1903	018	0	1	01	01	H1903_018_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H1906	001	0	1	09	04	H1906_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1906	001	0	1	09	04	H1906_001_0	3	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1906	001	0	1	09	04	H1906_001_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1906	001	0	1	09	04	H1906_001_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1906	002	0	1	09	04	H1906_002_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1906	002	0	1	09	04	H1906_002_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1906	002	0	1	09	04	H1906_002_0	3	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1906	002	0	1	09	04	H1906_002_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1906	003	0	1	09	04	H1906_003_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1906	003	0	1	09	04	H1906_003_0	3	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1906	003	0	1	09	04	H1906_003_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1906	003	0	1	09	04	H1906_003_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1906	006	0	1	09	04	H1906_006_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1906	006	0	1	09	04	H1906_006_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1906	006	0	1	09	04	H1906_006_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1906	006	0	1	09	04	H1906_006_0	4	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1906	007	0	1	09	04	H1906_007_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1906	007	0	1	09	04	H1906_007_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1906	007	0	1	09	04	H1906_007_0	4	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1906	007	0	1	09	04	H1906_007_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1906	008	0	1	09	04	H1906_008_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1906	008	0	1	09	04	H1906_008_0	4	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1906	008	0	1	09	04	H1906_008_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1906	008	0	1	09	04	H1906_008_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1951	001	0	1	01	01	H1951_001_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H1951	001	0	1	01	01	H1951_001_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1951	001	0	1	01	01	H1951_001_0	5	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H1951	001	0	1	01	01	H1951_001_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H1951	005	0	1	01	01	H1951_005_0	5	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H1951	005	0	1	01	01	H1951_005_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	50.00									4
H1951	005	0	1	01	01	H1951_005_0	5	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	40.00	120.00								40.00			40.00	100.00									4
H1951	005	0	1	01	01	H1951_005_0	5	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H1951	005	0	1	01	01	H1951_005_0	5	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H1951	005	0	1	01	01	H1951_005_0	5	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H1951	005	0	1	01	01	H1951_005_0	5	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00								1	4
H1951	005	0	1	01	01	H1951_005_0	5	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H1961	001	0	1	01	01	H1961_001_0	2	4	1	Specialty	100010	1	1	Specialty	000011011011011000000				30	90		30	90		30	90		30	90								Specialty	2	1	000011011011011000000		Specialty				20	20		20	20		20	20		20	20								Specialty																							4
H1961	001	0	1	01	01	H1961_001_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011011001000000				30	90		30	90		30	90			90								Non-Preferred Brand	2	2		000011011011001000000	Non-Preferred Brand																						Non-Preferred Brand				40.00	40.00		40.00	120.00		40.00	120.00			40.00									4
H1961	001	0	1	01	01	H1961_001_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011011001000000				30	90		30	90		30	90			90								Preferred Brand	2	2		000011011011001000000	Preferred Brand																						Preferred Brand				25.00	25.00		25.00	75.00		25.00	75.00			25.00									4
H1961	001	0	1	01	01	H1961_001_0	2	1	1	Generic	011100	1	2	Generic	000011011011001000000				30	90		30	90		30	90			90								Generic	2	2		000011011011001000000	Generic																						Generic				5.00	0.00		5.00	15.00		5.00	15.00			0.00									4
H1961	002	0	1	02	01	H1961_002_0	4	1	1	Generic	011100	1	2	Generic	000011011011001000000				30	90		30	90		30	90			90								Generic	2	2		000011011011001000000	Generic																						Generic				5.00	0.00		5.00	15.00		5.00	15.00			0.00									4
H1961	002	0	1	02	01	H1961_002_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011011001000000				30	90		30	90		30	90			90								Preferred Brand	2	2		000011011011001000000	Preferred Brand																						Preferred Brand				25.00	25.00		25.00	75.00		25.00	75.00			25.00									4
H1961	002	0	1	02	01	H1961_002_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011011001000000				30	90		30	90		30	90			90								Non-Preferred Brand	2	2		000011011011001000000	Non-Preferred Brand																						Non-Preferred Brand				40.00	40.00		40.00	120.00		40.00	120.00			40.00									4
H1961	002	0	1	02	01	H1961_002_0	4	4	1	Specialty	100010	1	1	Specialty	000011011011011000000				30	90		30	90		30	90		30	90								Specialty	2	1	000011011011011000000		Specialty				20	20		20	20		20	20		20	20								Specialty																							4
H2001	001	0	1	04	01	H2001_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2001	001	0	1	04	01	H2001_001_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2001	001	0	1	04	01	H2001_001_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2001	001	0	1	04	01	H2001_001_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2001	003	0	1	04	01	H2001_003_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2001	003	0	1	04	01	H2001_003_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2001	003	0	1	04	01	H2001_003_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2001	003	0	1	04	01	H2001_003_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2001	007	0	1	04	01	H2001_007_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2001	007	0	1	04	01	H2001_007_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2001	007	0	1	04	01	H2001_007_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2001	007	0	1	04	01	H2001_007_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2003	001	0	1	04	01	H2003_001_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H2003	001	0	1	04	01	H2003_001_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H2003	001	0	1	04	01	H2003_001_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H2003	001	0	1	04	01	H2003_001_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H2003	002	0	1	04	01	H2003_002_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2003	002	0	1	04	01	H2003_002_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2003	002	0	1	04	01	H2003_002_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2003	002	0	1	04	01	H2003_002_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2108	002	0	1	01	01	H2108_002_0	6	1	1	Generic	010000		2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
H2108	002	0	1	01	01	H2108_002_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00	87.00		29.00	58.00									3
H2108	002	0	1	01	01	H2108_002_0	6	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	55.00	165.00								55.00	165.00		55.00	110.00									3
H2108	002	0	1	01	01	H2108_002_0	6	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
H2108	018	0	1	01	01	H2108_018_0	9	1	1	Generic	010000		2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
H2108	018	0	1	01	01	H2108_018_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00	87.00		29.00	58.00									3
H2108	018	0	1	01	01	H2108_018_0	9	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	55.00	165.00								55.00	165.00		55.00	110.00									3
H2108	018	0	1	01	01	H2108_018_0	9	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
H2111	001	0	1	04	01	H2111_001_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H2111	001	0	1	04	01	H2111_001_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H2111	001	0	1	04	01	H2111_001_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H2111	001	0	1	04	01	H2111_001_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H2111	002	0	1	04	01	H2111_002_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H2111	002	0	1	04	01	H2111_002_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H2111	002	0	1	04	01	H2111_002_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H2111	002	0	1	04	01	H2111_002_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H2111	003	0	1	04	01	H2111_003_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H2111	003	0	1	04	01	H2111_003_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H2111	003	0	1	04	01	H2111_003_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H2111	003	0	1	04	01	H2111_003_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H2112	002	0	1	01	01	H2112_002_0	3	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H2112	002	0	1	01	01	H2112_002_0	3	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H2112	002	0	1	01	01	H2112_002_0	3	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H2112	002	0	1	01	01	H2112_002_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H2112	002	0	1	01	01	H2112_002_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H2112	002	0	1	01	01	H2112_002_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H2112	002	0	1	01	01	H2112_002_0	3	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H2112	002	0	1	01	01	H2112_002_0	3	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H2112	003	0	1	01	01	H2112_003_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H2112	003	0	1	01	01	H2112_003_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H2112	003	0	1	01	01	H2112_003_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H2112	007	0	1	01	01	H2112_007_0	3	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H2112	007	0	1	01	01	H2112_007_0	3	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H2112	007	0	1	01	01	H2112_007_0	3	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H2112	007	0	1	01	01	H2112_007_0	3	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H2112	007	0	1	01	01	H2112_007_0	3	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H2112	007	0	1	01	01	H2112_007_0	3	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H2112	009	0	1	01	01	H2112_009_0	3	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H2112	009	0	1	01	01	H2112_009_0	3	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H2112	009	0	1	01	01	H2112_009_0	3	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H2112	009	0	1	01	01	H2112_009_0	3	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H2112	009	0	1	01	01	H2112_009_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H2112	009	0	1	01	01	H2112_009_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H2112	009	0	1	01	01	H2112_009_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H2112	009	0	1	01	01	H2112_009_0	3	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H2112	011	0	1	01	01	H2112_011_0	3	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H2112	011	0	1	01	01	H2112_011_0	3	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H2112	011	0	1	01	01	H2112_011_0	3	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H2112	012	0	1	01	01	H2112_012_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H2112	012	0	1	01	01	H2112_012_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H2112	012	0	1	01	01	H2112_012_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H2150	002	0	1	18	06	H2150_002_0	4	3	1	Specialty	000010	1	1	Specialty	000010010010000010010				30			30			30						30			30			Specialty	2	2		000010010010000010010	Specialty																						Specialty				100.00			150.00			150.00						100.00			150.00				4
H2150	002	0	1	18	06	H2150_002_0	4	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H2150	002	0	1	18	06	H2150_002_0	4	3	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2150	002	0	1	18	06	H2150_002_0	4	1	1	Generic	010000	1	2	Generic	000011011010000011011				30	90		30	90		30						30	90		30	90		Generic	2	2		000011011010000011011	Generic																						Generic				10.00	30.00		20.00	60.00		20.00						7.00	21.00		20.00	60.00			4
H2150	002	0	1	18	06	H2150_002_0	4	2	1	Brand	000010	1	2	Brand	000011011010000011011				30	90		30	90		30						30	90		30	90		Brand	2	2		000011011010000011011	Brand																						Brand				35.00	105.00		55.00	165.00		55.00						30.00	90.00		55.00	165.00			4
H2150	002	0	1	18	06	H2150_002_0	4	1	3	Generic	010000	1	2	Generic	000011011010000011011				30	90		30	90		30						30	90		30	90		Generic	2	2		000011011010000011011	Generic																						Generic				10.00	30.00		20.00	60.00		20.00						7.00	21.00		20.00	60.00		1	4
H2150	009	0	1	18	06	H2150_009_0	4	1	1	Generic	010000		2	Generic	000011011010000011011				30	90		30	90		30						30	90		30	90		Generic	2	2		000011011010000011011	Generic																						Generic				10.00	30.00		20.00	60.00		20.00						7.00	21.00		20.00	60.00			3
H2150	009	0	1	18	06	H2150_009_0	4	3	1	Specialty	000010		1	Specialty	000010010010000010010				30			30			30						30			30			Specialty	2	2		000010010010000010010	Specialty																						Specialty				100.00			150.00			150.00						100.00			150.00				3
H2150	009	0	1	18	06	H2150_009_0	4	2	1	Brand	000010		2	Brand	000011011010000011011				30	90		30	90		30						30	90		30	90		Brand	2	2		000011011010000011011	Brand																						Brand				35.00	105.00		55.00	165.00		55.00						30.00	90.00		55.00	165.00			3
H2174	002	0	1	01	01	H2174_002_0	11	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2174	002	0	1	01	01	H2174_002_0	11	1	3	Generic	010000	1	2	Generic	011000000011001000000	31	90								31	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	7.00	14.00								7.00	14.00			14.00								1	4
H2174	002	0	1	01	01	H2174_002_0	11	1	1	Generic	010000	1	2	Generic	011000000011001000000	31	90								31	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	7.00	14.00								7.00	14.00			14.00									4
H2174	002	0	1	01	01	H2174_002_0	11	3	3	Non-Preferred Brand	100010	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H2174	002	0	1	01	01	H2174_002_0	11	3	1	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00	120.00			120.00									4
H2174	002	0	1	01	01	H2174_002_0	11	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	31	90								31	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	30.00	60.00								30.00	60.00			60.00									4
H2226	001	0	1	36	05	H2226_001_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2226	001	0	1	36	05	H2226_001_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2226	001	0	1	36	05	H2226_001_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2226	001	0	1	36	05	H2226_001_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2228	001	0	1	04	01	H2228_001_0	5	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H2228	001	0	1	04	01	H2228_001_0	5	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H2228	001	0	1	04	01	H2228_001_0	5	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H2228	001	0	1	04	01	H2228_001_0	5	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H2228	002	0	1	04	01	H2228_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2228	002	0	1	04	01	H2228_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2228	002	0	1	04	01	H2228_002_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2228	002	0	1	04	01	H2228_002_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2228	004	0	1	04	01	H2228_004_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2228	004	0	1	04	01	H2228_004_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2228	004	0	1	04	01	H2228_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2228	004	0	1	04	01	H2228_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2228	006	0	1	04	01	H2228_006_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2228	006	0	1	04	01	H2228_006_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2228	006	0	1	04	01	H2228_006_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2228	006	0	1	04	01	H2228_006_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2228	007	0	1	04	01	H2228_007_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2228	007	0	1	04	01	H2228_007_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2228	007	0	1	04	01	H2228_007_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2228	007	0	1	04	01	H2228_007_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2228	008	0	1	04	01	H2228_008_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2228	008	0	1	04	01	H2228_008_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2228	008	0	1	04	01	H2228_008_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2228	008	0	1	04	01	H2228_008_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2229	010	1	1	04	01	H2229_010_1	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2229	010	1	1	04	01	H2229_010_1	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2229	010	1	1	04	01	H2229_010_1	3	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2229	010	2	1	04	01	H2229_010_2	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2229	010	2	1	04	01	H2229_010_2	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2229	010	2	1	04	01	H2229_010_2	3	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2229	011	1	1	04	01	H2229_011_1	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2229	011	1	1	04	01	H2229_011_1	3	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2229	011	1	1	04	01	H2229_011_1	3	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2229	011	1	1	04	01	H2229_011_1	3	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2229	011	1	1	04	01	H2229_011_1	3	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2229	011	1	1	04	01	H2229_011_1	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2229	011	2	1	04	01	H2229_011_2	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2229	011	2	1	04	01	H2229_011_2	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2229	011	2	1	04	01	H2229_011_2	3	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2229	011	2	1	04	01	H2229_011_2	3	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2229	011	2	1	04	01	H2229_011_2	3	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2229	011	2	1	04	01	H2229_011_2	3	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2230	002	0	1	04	01	H2230_002_0	5	1	1	Generic	010000	3	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	10.00	30.00								10.00	30.00		10.00	20.00									4
H2230	002	0	1	04	01	H2230_002_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand	2	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00		60.00	120.00									4
H2230	002	0	1	04	01	H2230_002_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00	96.00		32.00	64.00									4
H2230	006	0	1	04	01	H2230_006_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	28.00	84.00								28.00	84.00		28.00	56.00									4
H2230	006	0	1	04	01	H2230_006_0	5	1	1	Generic	010000	3	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		8.00	16.00									4
H2230	006	0	1	04	01	H2230_006_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand	2	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00		58.00	116.00									4
H2230	006	0	1	04	01	H2230_006_0	5	1	3	Generic	010000	3	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		8.00	16.00								1	4
H2230	006	0	1	04	01	H2230_006_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2230	006	0	1	04	01	H2230_006_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H2237	001	0	1	01	01	H2237_001_0	8	2	1	Brand	000010	1	2	Brand	010000000010000000000	30									30												Brand	2	2		010000000010000000000	Brand																						Brand	40.00									40.00													4
H2237	001	0	1	01	01	H2237_001_0	8	1	1	Generic	010000	1	2	Generic	010000000010000000000	30									30												Generic	2	2		010000000010000000000	Generic																						Generic	0.00									0.00													4
H2237	002	0	1	01	01	H2237_002_0	8	1	1	Generic	010000	1	2	Generic	010000000010000000000	30									30												Generic	2	2		010000000010000000000	Generic																						Generic	0.00									0.00													4
H2237	002	0	1	01	01	H2237_002_0	8	2	1	Brand	000010	1	2	Brand	010000000010000000000	30									30												Brand	2	2		010000000010000000000	Brand																						Brand	40.00									40.00													4
H2256	001	1	1	01	01	H2256_001_1	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2256	001	1	1	01	01	H2256_001_1	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	001	1	1	01	01	H2256_001_1	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2256	001	1	1	01	01	H2256_001_1	4	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2256	001	1	1	01	01	H2256_001_1	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2256	001	1	1	01	01	H2256_001_1	4	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2256	001	2	1	01	01	H2256_001_2	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	001	2	1	01	01	H2256_001_2	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2256	001	2	1	01	01	H2256_001_2	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2256	001	2	1	01	01	H2256_001_2	4	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2256	001	2	1	01	01	H2256_001_2	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2256	001	2	1	01	01	H2256_001_2	4	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2256	001	3	1	01	01	H2256_001_3	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2256	001	3	1	01	01	H2256_001_3	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	001	3	1	01	01	H2256_001_3	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2256	001	3	1	01	01	H2256_001_3	4	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2256	001	3	1	01	01	H2256_001_3	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2256	001	3	1	01	01	H2256_001_3	4	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2256	001	4	1	01	01	H2256_001_4	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	001	4	1	01	01	H2256_001_4	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2256	001	4	1	01	01	H2256_001_4	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2256	001	4	1	01	01	H2256_001_4	4	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2256	001	4	1	01	01	H2256_001_4	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2256	001	4	1	01	01	H2256_001_4	4	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2256	001	5	1	01	01	H2256_001_5	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	001	5	1	01	01	H2256_001_5	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2256	001	5	1	01	01	H2256_001_5	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2256	001	5	1	01	01	H2256_001_5	4	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2256	001	5	1	01	01	H2256_001_5	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2256	001	5	1	01	01	H2256_001_5	4	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2256	015	1	1	01	01	H2256_015_1	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	015	1	1	01	01	H2256_015_1	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2256	015	1	1	01	01	H2256_015_1	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2256	015	2	1	01	01	H2256_015_2	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	015	2	1	01	01	H2256_015_2	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2256	015	2	1	01	01	H2256_015_2	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2256	015	3	1	01	01	H2256_015_3	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2256	015	3	1	01	01	H2256_015_3	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	015	3	1	01	01	H2256_015_3	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2256	015	4	1	01	01	H2256_015_4	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	015	4	1	01	01	H2256_015_4	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2256	015	4	1	01	01	H2256_015_4	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2256	015	5	1	01	01	H2256_015_5	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	015	5	1	01	01	H2256_015_5	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2256	015	5	1	01	01	H2256_015_5	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2256	017	1	1	01	01	H2256_017_1	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2256	017	1	1	01	01	H2256_017_1	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	017	1	1	01	01	H2256_017_1	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2256	017	1	1	01	01	H2256_017_1	4	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2256	017	1	1	01	01	H2256_017_1	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2256	017	1	1	01	01	H2256_017_1	4	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2256	017	2	1	01	01	H2256_017_2	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	017	2	1	01	01	H2256_017_2	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2256	017	2	1	01	01	H2256_017_2	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2256	017	2	1	01	01	H2256_017_2	4	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2256	017	2	1	01	01	H2256_017_2	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2256	017	2	1	01	01	H2256_017_2	4	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2256	017	3	1	01	01	H2256_017_3	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	017	3	1	01	01	H2256_017_3	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2256	017	3	1	01	01	H2256_017_3	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2256	017	3	1	01	01	H2256_017_3	4	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2256	017	3	1	01	01	H2256_017_3	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2256	017	3	1	01	01	H2256_017_3	4	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2256	017	4	1	01	01	H2256_017_4	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2256	017	4	1	01	01	H2256_017_4	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2256	017	4	1	01	01	H2256_017_4	4	1	3	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00								1	4
H2256	017	4	1	01	01	H2256_017_4	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2256	017	4	1	01	01	H2256_017_4	4	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2256	017	4	1	01	01	H2256_017_4	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	018	1	1	01	01	H2256_018_1	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2256	018	1	1	01	01	H2256_018_1	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	018	1	1	01	01	H2256_018_1	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2256	018	2	1	01	01	H2256_018_2	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2256	018	2	1	01	01	H2256_018_2	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	018	2	1	01	01	H2256_018_2	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2256	018	3	1	01	01	H2256_018_3	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	018	3	1	01	01	H2256_018_3	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2256	018	3	1	01	01	H2256_018_3	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2256	018	4	1	01	01	H2256_018_4	4	1	1	Tier 1	010000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2256	018	4	1	01	01	H2256_018_4	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	33.00	99.00								33.00				66.00									4
H2256	018	4	1	01	01	H2256_018_4	4	3	1	Tier 3	100000	3	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	53.00	159.00								53.00				106.00									4
H2261	005	0	1	01	01	H2261_005_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00	96.00		32.00	64.00									4
H2261	005	0	1	01	01	H2261_005_0	6	1	1	Generic	010000	3	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	10.00	30.00								10.00	30.00		10.00	20.00									4
H2261	005	0	1	01	01	H2261_005_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand	2	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00		60.00	120.00									4
H2261	011	0	1	01	01	H2261_011_0	6	1	3	Generic	010000	3	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		8.00	16.00								1	4
H2261	011	0	1	01	01	H2261_011_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2261	011	0	1	01	01	H2261_011_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand	2	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00		58.00	116.00									4
H2261	011	0	1	01	01	H2261_011_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H2261	011	0	1	01	01	H2261_011_0	6	1	1	Generic	010000	3	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		8.00	16.00									4
H2261	011	0	1	01	01	H2261_011_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	28.00	84.00								28.00	84.00		28.00	56.00									4
H2312	004	0	1	01	01	H2312_004_0	5	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Preferred Brand	2	2		011000000011001000000	Formulary Preferred Brand																						Formulary Preferred Brand	35.00	70.00								35.00	70.00			70.00									3
H2312	004	0	1	01	01	H2312_004_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00									3
H2312	004	0	1	01	01	H2312_004_0	5	4	1	Specialty Drugs	100001		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	2		010000000010000000000	Specialty Drugs																						Specialty Drugs	55.00									55.00													3
H2312	004	0	1	01	01	H2312_004_0	5	3	1	Formulary Non-Preferred Brand	100000		2	Formulary Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Non-Preferred Brand	2	2		011000000011001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	55.00	110.00								55.00	110.00			110.00									3
H2312	007	0	1	01	01	H2312_007_0	5	4	1	Specialty Drugs	100001		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	2		010000000010000000000	Specialty Drugs																						Specialty Drugs	55.00									55.00													3
H2312	007	0	1	01	01	H2312_007_0	5	3	1	Formulary Non-Preferred Brand	100000		2	Formulary Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Non-Preferred Brand	2	2		011000000011001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	55.00	110.00								55.00	110.00			110.00									3
H2312	007	0	1	01	01	H2312_007_0	5	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Preferred Brand	2	2		011000000011001000000	Formulary Preferred Brand																						Formulary Preferred Brand	35.00	70.00								35.00	70.00			70.00									3
H2312	007	0	1	01	01	H2312_007_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00									3
H2312	009	0	1	01	01	H2312_009_0	7	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Preferred Brand	2	2		011000000011001000000	Formulary Preferred Brand																						Formulary Preferred Brand	35.00	70.00								35.00	70.00			70.00									4
H2312	009	0	1	01	01	H2312_009_0	7	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00									4
H2312	009	0	1	01	01	H2312_009_0	7	4	1	Formulary Speciality	100001	1	1	Formulary Speciality	010000000010000000000	30									30												Formulary Speciality	2	2		010000000010000000000	Formulary Speciality																						Formulary Speciality	55.00									55.00													4
H2312	009	0	1	01	01	H2312_009_0	7	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00								1	4
H2312	009	0	1	01	01	H2312_009_0	7	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H2312	009	0	1	01	01	H2312_009_0	7	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Non-Preferred Brand	2	2		011000000011001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	55.00	110.00								55.00	110.00			110.00									4
H2312	009	0	1	01	01	H2312_009_0	7	4	3	Formulary Speciality	100001	1	1	Formulary Speciality																							Formulary Speciality					Formulary Speciality																						Formulary Speciality																						2	4
H2312	009	0	1	01	01	H2312_009_0	7	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
H2312	010	0	1	01	01	H2312_010_0	7	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
H2312	010	0	1	01	01	H2312_010_0	7	4	3	Formulary Speciality	100001	1	1	Formulary Speciality																							Formulary Speciality					Formulary Speciality																						Formulary Speciality																						2	4
H2312	010	0	1	01	01	H2312_010_0	7	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H2312	010	0	1	01	01	H2312_010_0	7	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00								1	4
H2312	010	0	1	01	01	H2312_010_0	7	4	1	Formulary Speciality	100001	1	1	Formulary Speciality	010000000010000000000	30									30												Formulary Speciality	2	2		010000000010000000000	Formulary Speciality																						Formulary Speciality	55.00									55.00													4
H2312	010	0	1	01	01	H2312_010_0	7	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00									4
H2312	010	0	1	01	01	H2312_010_0	7	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Preferred Brand	2	2		011000000011001000000	Formulary Preferred Brand																						Formulary Preferred Brand	35.00	70.00								35.00	70.00			70.00									4
H2312	010	0	1	01	01	H2312_010_0	7	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Non-Preferred Brand	2	2		011000000011001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	55.00	110.00								55.00	110.00			110.00									4
H2319	008	3	1	09	04	H2319_008_3	4	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	008	3	1	09	04	H2319_008_3	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	008	3	1	09	04	H2319_008_3	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	008	3	1	09	04	H2319_008_3	4	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	008	3	1	09	04	H2319_008_3	4	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	008	4	1	09	04	H2319_008_4	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	008	4	1	09	04	H2319_008_4	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	008	4	1	09	04	H2319_008_4	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	008	4	1	09	04	H2319_008_4	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	008	4	1	09	04	H2319_008_4	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	008	5	1	09	04	H2319_008_5	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	008	5	1	09	04	H2319_008_5	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	008	5	1	09	04	H2319_008_5	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	008	5	1	09	04	H2319_008_5	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	008	5	1	09	04	H2319_008_5	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	008	7	1	09	04	H2319_008_7	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	008	7	1	09	04	H2319_008_7	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	008	7	1	09	04	H2319_008_7	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	008	7	1	09	04	H2319_008_7	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	008	7	1	09	04	H2319_008_7	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	008	8	1	09	04	H2319_008_8	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	008	8	1	09	04	H2319_008_8	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	008	8	1	09	04	H2319_008_8	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	008	8	1	09	04	H2319_008_8	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	008	8	1	09	04	H2319_008_8	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	009	1	1	09	04	H2319_009_1	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	009	1	1	09	04	H2319_009_1	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	009	1	1	09	04	H2319_009_1	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	009	1	1	09	04	H2319_009_1	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	009	1	1	09	04	H2319_009_1	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	009	2	1	09	04	H2319_009_2	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	009	2	1	09	04	H2319_009_2	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	009	2	1	09	04	H2319_009_2	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	009	2	1	09	04	H2319_009_2	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	009	2	1	09	04	H2319_009_2	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	009	3	1	09	04	H2319_009_3	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	009	3	1	09	04	H2319_009_3	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	009	3	1	09	04	H2319_009_3	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	009	3	1	09	04	H2319_009_3	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	009	3	1	09	04	H2319_009_3	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	009	4	1	09	04	H2319_009_4	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	009	4	1	09	04	H2319_009_4	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	009	4	1	09	04	H2319_009_4	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	009	4	1	09	04	H2319_009_4	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	009	4	1	09	04	H2319_009_4	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	009	5	1	09	04	H2319_009_5	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	009	5	1	09	04	H2319_009_5	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	009	5	1	09	04	H2319_009_5	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	009	5	1	09	04	H2319_009_5	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	009	5	1	09	04	H2319_009_5	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	009	6	1	09	04	H2319_009_6	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	009	6	1	09	04	H2319_009_6	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	009	6	1	09	04	H2319_009_6	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	009	6	1	09	04	H2319_009_6	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	009	6	1	09	04	H2319_009_6	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	010	1	1	09	04	H2319_010_1	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	010	1	1	09	04	H2319_010_1	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	010	1	1	09	04	H2319_010_1	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	010	1	1	09	04	H2319_010_1	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	010	1	1	09	04	H2319_010_1	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	010	1	1	09	04	H2319_010_1	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	010	1	1	09	04	H2319_010_1	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	010	1	1	09	04	H2319_010_1	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	010	1	1	09	04	H2319_010_1	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	010	1	1	09	04	H2319_010_1	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	010	2	1	09	04	H2319_010_2	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	010	2	1	09	04	H2319_010_2	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	010	2	1	09	04	H2319_010_2	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	010	2	1	09	04	H2319_010_2	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	010	2	1	09	04	H2319_010_2	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	010	2	1	09	04	H2319_010_2	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	010	2	1	09	04	H2319_010_2	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	010	2	1	09	04	H2319_010_2	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	010	2	1	09	04	H2319_010_2	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	010	2	1	09	04	H2319_010_2	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	010	3	1	09	04	H2319_010_3	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	010	3	1	09	04	H2319_010_3	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	010	3	1	09	04	H2319_010_3	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	010	3	1	09	04	H2319_010_3	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	010	3	1	09	04	H2319_010_3	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	010	3	1	09	04	H2319_010_3	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	010	3	1	09	04	H2319_010_3	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	010	3	1	09	04	H2319_010_3	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	010	3	1	09	04	H2319_010_3	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	010	3	1	09	04	H2319_010_3	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	010	4	1	09	04	H2319_010_4	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	010	4	1	09	04	H2319_010_4	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	010	4	1	09	04	H2319_010_4	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	010	4	1	09	04	H2319_010_4	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	010	4	1	09	04	H2319_010_4	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	010	4	1	09	04	H2319_010_4	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	010	4	1	09	04	H2319_010_4	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	010	4	1	09	04	H2319_010_4	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	010	4	1	09	04	H2319_010_4	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	010	4	1	09	04	H2319_010_4	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	010	5	1	09	04	H2319_010_5	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	010	5	1	09	04	H2319_010_5	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	010	5	1	09	04	H2319_010_5	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	010	5	1	09	04	H2319_010_5	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	010	5	1	09	04	H2319_010_5	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	010	5	1	09	04	H2319_010_5	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	010	5	1	09	04	H2319_010_5	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	010	5	1	09	04	H2319_010_5	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	010	5	1	09	04	H2319_010_5	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	010	5	1	09	04	H2319_010_5	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	010	6	1	09	04	H2319_010_6	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	010	6	1	09	04	H2319_010_6	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	010	6	1	09	04	H2319_010_6	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	010	6	1	09	04	H2319_010_6	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	010	6	1	09	04	H2319_010_6	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	010	6	1	09	04	H2319_010_6	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	010	6	1	09	04	H2319_010_6	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	010	6	1	09	04	H2319_010_6	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	010	6	1	09	04	H2319_010_6	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	010	6	1	09	04	H2319_010_6	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	011	1	1	09	04	H2319_011_1	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	011	1	1	09	04	H2319_011_1	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	011	1	1	09	04	H2319_011_1	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	011	1	1	09	04	H2319_011_1	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	011	1	1	09	04	H2319_011_1	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	011	1	1	09	04	H2319_011_1	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	011	1	1	09	04	H2319_011_1	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	011	1	1	09	04	H2319_011_1	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	011	1	1	09	04	H2319_011_1	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	011	1	1	09	04	H2319_011_1	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	011	2	1	09	04	H2319_011_2	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	011	2	1	09	04	H2319_011_2	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	011	2	1	09	04	H2319_011_2	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	011	2	1	09	04	H2319_011_2	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	011	2	1	09	04	H2319_011_2	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	011	2	1	09	04	H2319_011_2	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	011	2	1	09	04	H2319_011_2	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	011	2	1	09	04	H2319_011_2	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	011	2	1	09	04	H2319_011_2	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	011	2	1	09	04	H2319_011_2	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	011	3	1	09	04	H2319_011_3	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	011	3	1	09	04	H2319_011_3	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	011	3	1	09	04	H2319_011_3	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	011	3	1	09	04	H2319_011_3	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	011	3	1	09	04	H2319_011_3	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	011	3	1	09	04	H2319_011_3	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	011	3	1	09	04	H2319_011_3	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	011	3	1	09	04	H2319_011_3	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	011	3	1	09	04	H2319_011_3	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	011	3	1	09	04	H2319_011_3	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	011	4	1	09	04	H2319_011_4	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	011	4	1	09	04	H2319_011_4	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	011	4	1	09	04	H2319_011_4	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	011	4	1	09	04	H2319_011_4	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	011	4	1	09	04	H2319_011_4	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	011	4	1	09	04	H2319_011_4	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	011	4	1	09	04	H2319_011_4	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	011	4	1	09	04	H2319_011_4	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	011	4	1	09	04	H2319_011_4	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	011	4	1	09	04	H2319_011_4	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	011	5	1	09	04	H2319_011_5	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	011	5	1	09	04	H2319_011_5	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	011	5	1	09	04	H2319_011_5	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	011	5	1	09	04	H2319_011_5	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	011	5	1	09	04	H2319_011_5	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	011	5	1	09	04	H2319_011_5	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	011	5	1	09	04	H2319_011_5	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2319	011	5	1	09	04	H2319_011_5	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	011	5	1	09	04	H2319_011_5	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	011	5	1	09	04	H2319_011_5	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	011	6	1	09	04	H2319_011_6	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
H2319	011	6	1	09	04	H2319_011_6	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
H2319	011	6	1	09	04	H2319_011_6	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
H2319	011	6	1	09	04	H2319_011_6	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2319	011	6	1	09	04	H2319_011_6	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
H2319	011	6	1	09	04	H2319_011_6	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H2319	011	6	1	09	04	H2319_011_6	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2319	011	6	1	09	04	H2319_011_6	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
H2319	011	6	1	09	04	H2319_011_6	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
H2319	011	6	1	09	04	H2319_011_6	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2320	004	1	1	02	01	H2320_004_1	3	2	1	Preferred Brand on Formulary	000001	1	2	Preferred Brand on Formulary	011000000011001000000	31	90								31	90			90								Preferred Brand on Formulary	2	2		011000000011001000000	Preferred Brand on Formulary																						Preferred Brand on Formulary	30.00	90.00								30.00	90.00			60.00									4
H2320	004	1	1	02	01	H2320_004_1	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00	162.00			108.00									4
H2320	004	1	1	02	01	H2320_004_1	3	1	1	Generic on Formulary	010000	1	2	Generic on Formulary	011000000011001000000	31	90								31	90			90								Generic on Formulary	2	2		011000000011001000000	Generic on Formulary																						Generic on Formulary	10.00	30.00								10.00	30.00			20.00									4
H2320	004	2	1	02	01	H2320_004_2	3	2	1	Preferred Brand on Formulary	000001	1	2	Preferred Brand on Formulary	011000000011001000000	31	90								31	90			90								Preferred Brand on Formulary	2	2		011000000011001000000	Preferred Brand on Formulary																						Preferred Brand on Formulary	30.00	90.00								30.00	90.00			60.00									4
H2320	004	2	1	02	01	H2320_004_2	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00	162.00			108.00									4
H2320	004	2	1	02	01	H2320_004_2	3	1	1	Generic on Formulary	010000	1	2	Generic on Formulary	011000000011001000000	31	90								31	90			90								Generic on Formulary	2	2		011000000011001000000	Generic on Formulary																						Generic on Formulary	10.00	30.00								10.00	30.00			20.00									4
H2320	004	3	1	02	01	H2320_004_3	3	1	1	Generic on Formulary	010000	1	2	Generic on Formulary	011000000011001000000	31	90								31	90			90								Generic on Formulary	2	2		011000000011001000000	Generic on Formulary																						Generic on Formulary	10.00	30.00								10.00	30.00			20.00									4
H2320	004	3	1	02	01	H2320_004_3	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00	162.00			108.00									4
H2320	004	3	1	02	01	H2320_004_3	3	2	1	Preferred Brand on Formulary	000001	1	2	Preferred Brand on Formulary	011000000011001000000	31	90								31	90			90								Preferred Brand on Formulary	2	2		011000000011001000000	Preferred Brand on Formulary																						Preferred Brand on Formulary	30.00	90.00								30.00	90.00			60.00									4
H2320	005	1	1	02	01	H2320_005_1	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H2320	005	1	1	02	01	H2320_005_1	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00	162.00			108.00									4
H2320	005	1	1	02	01	H2320_005_1	3	2	1	Preferred Brand on Formulary	000001	1	2	Preferred Brand on Formulary	011000000011001000000	31	90								31	90			90								Preferred Brand on Formulary	2	2		011000000011001000000	Preferred Brand on Formulary																						Preferred Brand on Formulary	30.00	90.00								30.00	90.00			60.00									4
H2320	005	1	1	02	01	H2320_005_1	3	2	3	Preferred Brand on Formulary	000001	1	2	Preferred Brand on Formulary																							Preferred Brand on Formulary					Preferred Brand on Formulary																						Preferred Brand on Formulary																						2	4
H2320	005	1	1	02	01	H2320_005_1	3	1	3	Generic on Formulary	010000	1	2	Generic on Formulary	011000000011001000000	31	90								31	90			90								Generic on Formulary	2	2		011000000011001000000	Generic on Formulary																						Generic on Formulary	10.00	30.00								10.00	30.00			20.00								1	4
H2320	005	1	1	02	01	H2320_005_1	3	1	1	Generic on Formulary	010000	1	2	Generic on Formulary	011000000011001000000	31	90								31	90			90								Generic on Formulary	2	2		011000000011001000000	Generic on Formulary																						Generic on Formulary	10.00	30.00								10.00	30.00			20.00									4
H2320	005	2	1	02	01	H2320_005_2	3	1	1	Generic on Formulary	010000	1	2	Generic on Formulary	011000000011001000000	31	90								31	90			90								Generic on Formulary	2	2		011000000011001000000	Generic on Formulary																						Generic on Formulary	10.00	30.00								10.00	30.00			20.00									4
H2320	005	2	1	02	01	H2320_005_2	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H2320	005	2	1	02	01	H2320_005_2	3	2	1	Preferred Brand on Formulary	000001	1	2	Preferred Brand on Formulary	011000000011001000000	31	90								31	90			90								Preferred Brand on Formulary	2	2		011000000011001000000	Preferred Brand on Formulary																						Preferred Brand on Formulary	30.00	90.00								30.00	90.00			60.00									4
H2320	005	2	1	02	01	H2320_005_2	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00	162.00			108.00									4
H2320	005	2	1	02	01	H2320_005_2	3	1	3	Generic on Formulary	010000	1	2	Generic on Formulary	011000000011001000000	31	90								31	90			90								Generic on Formulary	2	2		011000000011001000000	Generic on Formulary																						Generic on Formulary	10.00	30.00								10.00	30.00			20.00								1	4
H2320	005	2	1	02	01	H2320_005_2	3	2	3	Preferred Brand on Formulary	000001	1	2	Preferred Brand on Formulary																							Preferred Brand on Formulary					Preferred Brand on Formulary																						Preferred Brand on Formulary																						2	4
H2320	005	3	1	02	01	H2320_005_3	3	2	3	Preferred Brand on Formulary	000001	1	2	Preferred Brand on Formulary																							Preferred Brand on Formulary					Preferred Brand on Formulary																						Preferred Brand on Formulary																						2	4
H2320	005	3	1	02	01	H2320_005_3	3	1	3	Generic on Formulary	010000	1	2	Generic on Formulary	011000000011001000000	31	90								31	90			90								Generic on Formulary	2	2		011000000011001000000	Generic on Formulary																						Generic on Formulary	10.00	30.00								10.00	30.00			20.00								1	4
H2320	005	3	1	02	01	H2320_005_3	3	1	1	Generic on Formulary	010000	1	2	Generic on Formulary	011000000011001000000	31	90								31	90			90								Generic on Formulary	2	2		011000000011001000000	Generic on Formulary																						Generic on Formulary	10.00	30.00								10.00	30.00			20.00									4
H2320	005	3	1	02	01	H2320_005_3	3	2	1	Preferred Brand on Formulary	000001	1	2	Preferred Brand on Formulary	011000000011001000000	31	90								31	90			90								Preferred Brand on Formulary	2	2		011000000011001000000	Preferred Brand on Formulary																						Preferred Brand on Formulary	30.00	90.00								30.00	90.00			60.00									4
H2320	005	3	1	02	01	H2320_005_3	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00	162.00			108.00									4
H2320	005	3	1	02	01	H2320_005_3	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H2322	001	0	1	04	01	H2322_001_0	6	1	1	Formulary Generic	010000		2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00									3
H2322	001	0	1	04	01	H2322_001_0	6	3	1	Formulary Non-Preferred Brand	100000		2	Formulary Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Non-Preferred Brand	2	2		011000000011001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	55.00	110.00								55.00	110.00			110.00									3
H2322	001	0	1	04	01	H2322_001_0	6	4	1	Specialty Drugs	100001		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	2		010000000010000000000	Specialty Drugs																						Specialty Drugs	55.00									55.00													3
H2322	001	0	1	04	01	H2322_001_0	6	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Preferred Brand	2	2		011000000011001000000	Formulary Preferred Brand																						Formulary Preferred Brand	35.00	70.00								35.00	70.00			70.00									3
H2322	004	0	1	04	01	H2322_004_0	8	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H2322	004	0	1	04	01	H2322_004_0	8	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00								1	4
H2322	004	0	1	04	01	H2322_004_0	8	4	1	Formulary Speciality	100001	1	1	Formulary Speciality	010000000010000000000	30									30												Formulary Speciality	2	2		010000000010000000000	Formulary Speciality																						Formulary Speciality	55.00									55.00													4
H2322	004	0	1	04	01	H2322_004_0	8	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Non-Preferred Brand	2	2		011000000011001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	55.00	110.00								55.00	110.00			110.00									4
H2322	004	0	1	04	01	H2322_004_0	8	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Preferred Brand	2	2		011000000011001000000	Formulary Preferred Brand																						Formulary Preferred Brand	35.00	70.00								35.00	70.00			70.00									4
H2322	004	0	1	04	01	H2322_004_0	8	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00									4
H2322	004	0	1	04	01	H2322_004_0	8	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
H2322	004	0	1	04	01	H2322_004_0	8	4	3	Formulary Speciality	100001	1	1	Formulary Speciality																							Formulary Speciality					Formulary Speciality																						Formulary Speciality																						2	4
H2322	006	0	1	04	01	H2322_006_0	6	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Preferred Brand	2	2		011000000011001000000	Formulary Preferred Brand																						Formulary Preferred Brand	35.00	70.00								35.00	70.00			70.00									3
H2322	006	0	1	04	01	H2322_006_0	6	1	1	Formulary Generic	010000		2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00									3
H2322	006	0	1	04	01	H2322_006_0	6	4	1	Specialty Drugs	100001		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	2		010000000010000000000	Specialty Drugs																						Specialty Drugs	55.00									55.00													3
H2322	006	0	1	04	01	H2322_006_0	6	3	1	Formulary Non-Preferred Brand	100000		2	Formulary Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Non-Preferred Brand	2	2		011000000011001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	55.00	110.00								55.00	110.00			110.00									3
H2322	007	0	1	04	01	H2322_007_0	8	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H2322	007	0	1	04	01	H2322_007_0	8	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00									4
H2322	007	0	1	04	01	H2322_007_0	8	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Preferred Brand	2	2		011000000011001000000	Formulary Preferred Brand																						Formulary Preferred Brand	35.00	70.00								35.00	70.00			70.00									4
H2322	007	0	1	04	01	H2322_007_0	8	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Formulary Non-Preferred Brand	2	2		011000000011001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	55.00	110.00								55.00	110.00			110.00									4
H2322	007	0	1	04	01	H2322_007_0	8	4	3	Formulary Speciality	100001	1	1	Formulary Speciality																							Formulary Speciality					Formulary Speciality																						Formulary Speciality																						2	4
H2322	007	0	1	04	01	H2322_007_0	8	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
H2322	007	0	1	04	01	H2322_007_0	8	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000011001000000	30	90								30	90			90								Formulary Generic	2	2		011000000011001000000	Formulary Generic																						Formulary Generic	12.00	24.00								12.00	24.00			24.00								1	4
H2322	007	0	1	04	01	H2322_007_0	8	4	1	Formulary Speciality	100001	1	1	Formulary Speciality	010000000010000000000	30									30												Formulary Speciality	2	2		010000000010000000000	Formulary Speciality																						Formulary Speciality	55.00									55.00													4
H2323	002	0	1	01	01	H2323_002_0	22	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H2323	002	0	1	01	01	H2323_002_0	22	1	1	Generic	010000	1	2	Generic	000010000010000000000				30						30												Generic	2	2		000010000010000000000	Generic																						Generic				5.00						5.00													4
H2323	002	0	1	01	01	H2323_002_0	22	2	1	Brand	000010	1	2	Brand	000010000010000000000				30						30												Brand	2	1	000010000010000000000		Brand				25						25												Brand																							4
H2323	002	0	1	01	01	H2323_002_0	22	1	3	Generic	010000	1	2	Generic	000010000010000000000				30						30												Generic	2	2		000010000010000000000	Generic																						Generic				5.00						5.00												1	4
H2354	001	0	1	01	01	H2354_001_0	6	1	1	Generic	010000		2	Generic	011000000010011000000	34	90								34			34	90								Generic	1	2		011000000010011000000	Generic																						Generic	5.00	10.00								5.00			5.00	10.00									2
H2354	001	0	1	01	01	H2354_001_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010011000000	34	90								34			34	90								Preferred Brand	1	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	40.00								20.00			20.00	40.00									2
H2354	001	0	1	01	01	H2354_001_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010011000000	34	90								34			34	90								Non-Preferred Brand	1	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	90.00								45.00			45.00	90.00									2
H2354	001	0	1	01	01	H2354_001_0	6	4	1	Injectable and Miscellaneous Drugs	110001		2	Injectable and Miscellaneous Drugs	010000000010000000000	34									34												Injectable and Miscellaneous Drugs	1	4	010000000010000000000	010000000010000000000	Injectable and Miscellaneous Drugs	25									25												Injectable and Miscellaneous Drugs	125.00									125.00													2
H2354	001	0	1	01	01	H2354_001_0	6	5	1	Defined List of Over-The-Counter (OTC) Drugs	010001		2	Defined List of Over-The-Counter (OTC) Drugs	011000000010011000000	34	90								34			34	90								Defined List of Over-The-Counter (OTC) Drugs	1	2		011000000010011000000	Defined List of Over-The-Counter (OTC) Drugs																						Defined List of Over-The-Counter (OTC) Drugs	0.00	0.00								0.00			0.00	0.00									2
H2354	013	0	1	01	01	H2354_013_0	6	5	1	Defined List of Over-The-Counter (OTC) Drugs	010001	1	2	Defined List of Over-The-Counter (OTC) Drugs	011000000010010000000	34	90								34			34									Defined List of Over-The-Counter (OTC) Drugs	1	2		011000000010011000000	Defined List of Over-The-Counter (OTC) Drugs																						Defined List of Over-The-Counter (OTC) Drugs	0.00	0.00								0.00			0.00	0.00									4
H2354	013	0	1	01	01	H2354_013_0	6	4	1	Injectable and Miscellaneous Drugs	110001	1	2	Injectable and Miscellaneous Drugs	010000000010000000000	34									34												Injectable and Miscellaneous Drugs	1	4	010000000010000000000	010000000010000000000	Injectable and Miscellaneous Drugs	25									25												Injectable and Miscellaneous Drugs	125.00									125.00													4
H2354	013	0	1	01	01	H2354_013_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	34	90								34			34	90								Non-Preferred Brand	1	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	90.00								45.00			45.00	90.00									4
H2354	013	0	1	01	01	H2354_013_0	6	1	1	Generic	010000	1	2	Generic	011000000010011000000	34	90								34			34	90								Generic	1	2		011000000010011000000	Generic																						Generic	5.00	10.00								5.00			5.00	10.00									4
H2354	013	0	1	01	01	H2354_013_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	34	90								34			34	90								Preferred Brand	1	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	40.00								20.00			20.00	40.00									4
H2354	014	0	1	01	01	H2354_014_0	8	1	3	Generic	010000	1	2	Generic	011000000010011000000	34	90								34			34	90								Generic	1	2		011000000010011000000	Generic																						Generic	5.00	10.00								5.00			5.00	10.00								1	4
H2354	014	0	1	01	01	H2354_014_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2354	014	0	1	01	01	H2354_014_0	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H2354	014	0	1	01	01	H2354_014_0	8	4	3	Injectable and Miscellaneous Drugs	110001	1	2	Injectable and Miscellaneous Drugs																							Injectable and Miscellaneous Drugs					Injectable and Miscellaneous Drugs																						Injectable and Miscellaneous Drugs																						2	4
H2354	014	0	1	01	01	H2354_014_0	8	5	1	Defined List of Over-The-Counter (OTC) Drugs	010001	1	2	Defined List of Over-The-Counter (OTC) Drugs	011000000010011000000	34	90								34			34	90								Defined List of Over-The-Counter (OTC) Drugs	1	2		011000000010011000000	Defined List of Over-The-Counter (OTC) Drugs																						Defined List of Over-The-Counter (OTC) Drugs	0.00	0.00								0.00			0.00	0.00									4
H2354	014	0	1	01	01	H2354_014_0	8	4	1	Injectable and Miscellaneous Drugs	110001	1	2	Injectable and Miscellaneous Drugs	010000000010000000000	34									34												Injectable and Miscellaneous Drugs	1	4	010000000010000000000	010000000010000000000	Injectable and Miscellaneous Drugs	25									25												Injectable and Miscellaneous Drugs	125.00									125.00													4
H2354	014	0	1	01	01	H2354_014_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	34	90								34			34	90								Non-Preferred Brand	1	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	90.00								45.00			45.00	90.00									4
H2354	014	0	1	01	01	H2354_014_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	34	90								34			34	90								Preferred Brand	1	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	40.00								20.00			20.00	40.00									4
H2354	014	0	1	01	01	H2354_014_0	8	1	1	Generic	010000	1	2	Generic	011000000010011000000	34	90								34			34	90								Generic	1	2		011000000010011000000	Generic																						Generic	5.00	10.00								5.00			5.00	10.00									4
H2354	014	0	1	01	01	H2354_014_0	8	5	3	Defined List of Over-The-Counter (OTC) Drugs	010001	1	2	Defined List of Over-The-Counter (OTC) Drugs	011000000010011000000	34	90								34			34	90								Defined List of Over-The-Counter (OTC) Drugs	1	2		011000000010011000000	Defined List of Over-The-Counter (OTC) Drugs																						Defined List of Over-The-Counter (OTC) Drugs	0.00	0.00								0.00			0.00	0.00								1	4
H2406	001	0	1	04	01	H2406_001_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2406	001	0	1	04	01	H2406_001_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2406	001	0	1	04	01	H2406_001_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2406	001	0	1	04	01	H2406_001_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2408	001	0	1	09	04	H2408_001_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2408	001	0	1	09	04	H2408_001_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2408	001	0	1	09	04	H2408_001_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2408	001	0	1	09	04	H2408_001_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2408	011	0	1	09	04	H2408_011_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2408	011	0	1	09	04	H2408_011_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2408	011	0	1	09	04	H2408_011_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2408	011	0	1	09	04	H2408_011_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2408	013	0	1	09	04	H2408_013_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2408	013	0	1	09	04	H2408_013_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2408	013	0	1	09	04	H2408_013_0	8	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2408	013	0	1	09	04	H2408_013_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2408	015	0	1	09	04	H2408_015_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2408	015	0	1	09	04	H2408_015_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2408	015	0	1	09	04	H2408_015_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2408	015	0	1	09	04	H2408_015_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2409	006	0	1	09	04	H2409_006_0	3	1	1	Tier 1	010000		2	Tier 1	010011000010000001000	31			31	90					31							90					Tier 1	2	2		010011000010000001000	Tier 1																						Tier 1	10.00			10.00	30.00					10.00							20.00						3
H2409	006	0	1	09	04	H2409_006_0	3	4	1	Tier 4	000011		1	Tier 4	010011000010000000000	31			31	90					31												Tier 4	2	1	010011000010000001000		Tier 4	25			25	25					25							25					Tier 4																							3
H2409	006	0	1	09	04	H2409_006_0	3	3	1	Tier 3	100000		2	Tier 3	010011000010000001000	31			31	90					31							90					Tier 3	2	2		010011000010000001000	Tier 3																						Tier 3	54.00			54.00	162.00					54.00							108.00						3
H2409	006	0	1	09	04	H2409_006_0	3	2	1	Tier 2	000010		2	Tier 2	010011000010000000000	31			31	90					31												Tier 2	2	2		010011000010000001000	Tier 2																						Tier 2	27.00			27.00	81.00					27.00							54.00						3
H2410	015	0	1	09	04	H2410_015_0	4	1	1	Tier 1	010000		2	Tier 1	010011000010000001000	31			31	90					31							90					Tier 1	2	2		010011000010000001000	Tier 1																						Tier 1	10.00			10.00	30.00					10.00							20.00						3
H2410	015	0	1	09	04	H2410_015_0	4	2	1	Tier 2	000010		2	Tier 2	010011000010000000000	31			31	90					31												Tier 2	2	2		010011000010000001000	Tier 2																						Tier 2	27.00			27.00	81.00					27.00							54.00						3
H2410	015	0	1	09	04	H2410_015_0	4	3	1	Tier 3	100000		2	Tier 3	010011000010000001000	31			31	90					31							90					Tier 3	2	2		010011000010000001000	Tier 3																						Tier 3	54.00			54.00	162.00					54.00							108.00						3
H2410	015	0	1	09	04	H2410_015_0	4	4	1	Tier 4	000011		1	Tier 4	010011000010000000000	31			31	90					31												Tier 4	2	1	010011000010000001000		Tier 4	25			25	25					25							25					Tier 4																							3
H2411	002	0	1	04	01	H2411_002_0	5	1	1	Tier 1	001000	3	2	Tier 1	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	3.00	9.00	6.00							3.00	9.00	6.00	3.00	9.00	6.00								4
H2411	002	0	1	04	01	H2411_002_0	5	2	1	Tier 2	000101	3	2	Tier 2	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	20.00	60.00	40.00							20.00	60.00	40.00	20.00	60.00	40.00								4
H2411	002	0	1	04	01	H2411_002_0	5	3	1	Tier 3	100000	3	2	Tier 3	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H2450	001	0	1	18	06	H2450_001_0	3	3	1	Tier 3	100000		2	Tier 3	010011000010000001000	31			31	90					31							90					Tier 3	2	2		010011000010000001000	Tier 3																						Tier 3	54.00			54.00	162.00					54.00							108.00						3
H2450	001	0	1	18	06	H2450_001_0	3	4	1	Tier 4	000011		1	Tier 4	010011000010000000000	31			31	90					31												Tier 4	2	1	010011000010000001000		Tier 4	25			25	25					25							25					Tier 4																							3
H2450	001	0	1	18	06	H2450_001_0	3	1	1	Tier 1	010000		2	Tier 1	010011000010000001000	31			31	90					31							90					Tier 1	2	2		010011000010000001000	Tier 1																						Tier 1	10.00			10.00	30.00					10.00							20.00						3
H2450	001	0	1	18	06	H2450_001_0	3	2	1	Tier 2	000010		2	Tier 2	010011000010000000000	31			31	90					31												Tier 2	2	2		010011000010000001000	Tier 2																						Tier 2	27.00			27.00	81.00					27.00							54.00						3
H2450	002	0	1	18	06	H2450_002_0	3	3	1	Tier 3	100000		2	Tier 3	010011000010000001000	31			31	90					31							90					Tier 3	2	2		010011000010000001000	Tier 3																						Tier 3	54.00			54.00	162.00					54.00							108.00						3
H2450	002	0	1	18	06	H2450_002_0	3	2	1	Tier 2	000010		2	Tier 2	010011000010000000000	31			31	90					31												Tier 2	2	2		010011000010000001000	Tier 2																						Tier 2	27.00			27.00	81.00					27.00							54.00						3
H2450	002	0	1	18	06	H2450_002_0	3	1	1	Tier 1	010000		2	Tier 1	010011000010000001000	31			31	90					31							90					Tier 1	2	2		010011000010000001000	Tier 1																						Tier 1	10.00			10.00	30.00					10.00							20.00						3
H2450	002	0	1	18	06	H2450_002_0	3	4	1	Tier 4	000011		1	Tier 4	010011000010000000000	31			31	90					31												Tier 4	2	1	010011000010000001000		Tier 4	25			25	25					25							25					Tier 4																							3
H2450	005	0	1	18	06	H2450_005_0	3	1	1	Tier 1	010000	1	2	Tier 1	010011000010000001000	31			31	90					31							90					Tier 1	2	2		010011000010000001000	Tier 1																						Tier 1	10.00			10.00	30.00					10.00							20.00						4
H2450	005	0	1	18	06	H2450_005_0	3	2	1	Tier 2	000010	1	2	Tier 2	010011000010000000000	31			31	90					31												Tier 2	2	2		010011000010000001000	Tier 2																						Tier 2	27.00			27.00	81.00					27.00							54.00						4
H2450	005	0	1	18	06	H2450_005_0	3	3	1	Tier 3	100000	1	2	Tier 3	010011000010000001000	31			31	90					31							90					Tier 3	2	2		010011000010000001000	Tier 3																						Tier 3	54.00			54.00	162.00					54.00							108.00						4
H2450	005	0	1	18	06	H2450_005_0	3	4	1	Tier 4	000011	1	1	Tier 4	010011000010000000000	31			31	90					31												Tier 4	2	1	010011000010000001000		Tier 4	25			25	25					25							25					Tier 4																							4
H2450	005	0	1	18	06	H2450_005_0	3	1	3	Tier 1	010000	1	2	Tier 1	010011000010000000000	31			31	90					31												Tier 1	2	2		010011000010000001000	Tier 1																						Tier 1	10.00			10.00	30.00					10.00							20.00					1	4
H2450	005	0	1	18	06	H2450_005_0	3	2	3	Tier 2	000010	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2450	005	0	1	18	06	H2450_005_0	3	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2450	005	0	1	18	06	H2450_005_0	3	4	3	Tier 4	000011	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H2450	006	0	1	18	06	H2450_006_0	3	1	3	Tier 1	010000	1	2	Tier 1	010011000010000000000	31			31	90					31												Tier 1	2	2		010011000010000001000	Tier 1																						Tier 1	10.00			10.00	30.00					10.00							20.00					1	4
H2450	006	0	1	18	06	H2450_006_0	3	4	1	Tier 4	000011	1	1	Tier 4	010011000010000000000	31			31	90					31												Tier 4	2	1	010011000010000001000		Tier 4	25			25	25					25							25					Tier 4																							4
H2450	006	0	1	18	06	H2450_006_0	3	3	1	Tier 3	100000	1	2	Tier 3	010011000010000001000	31			31	90					31							90					Tier 3	2	2		010011000010000001000	Tier 3																						Tier 3	54.00			54.00	162.00					54.00							108.00						4
H2450	006	0	1	18	06	H2450_006_0	3	2	1	Tier 2	000010	1	2	Tier 2	010011000010000000000	31			31	90					31												Tier 2	2	2		010011000010000001000	Tier 2																						Tier 2	27.00			27.00	81.00					27.00							54.00						4
H2450	006	0	1	18	06	H2450_006_0	3	1	1	Tier 1	010000	1	2	Tier 1	010011000010000001000	31			31	90					31							90					Tier 1	2	2		010011000010000001000	Tier 1																						Tier 1	10.00			10.00	30.00					10.00							20.00						4
H2450	006	0	1	18	06	H2450_006_0	3	2	3	Tier 2	000010	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H2450	006	0	1	18	06	H2450_006_0	3	4	3	Tier 4	000011	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H2450	006	0	1	18	06	H2450_006_0	3	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H2450	007	0	1	18	06	H2450_007_0	3	1	1	Tier 1	010000		2	Tier 1	010011000010000001000	31			31	90					31							90					Tier 1	2	2		010011000010000001000	Tier 1																						Tier 1	10.00			10.00	30.00					10.00							20.00						3
H2450	007	0	1	18	06	H2450_007_0	3	2	1	Tier 2	000010		2	Tier 2	010011000010000000000	31			31	90					31												Tier 2	2	2		010011000010000001000	Tier 2																						Tier 2	27.00			27.00	81.00					27.00							54.00						3
H2450	007	0	1	18	06	H2450_007_0	3	3	1	Tier 3	100000		2	Tier 3	010011000010000001000	31			31	90					31							90					Tier 3	2	2		010011000010000001000	Tier 3																						Tier 3	54.00			54.00	162.00					54.00							108.00						3
H2450	007	0	1	18	06	H2450_007_0	3	4	1	Tier 4	000011		1	Tier 4	010011000010000000000	31			31	90					31												Tier 4	2	1	010011000010000001000		Tier 4	25			25	25					25							25					Tier 4																							3
H2459	002	0	1	02	01	H2459_002_0	4	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	20	20								20				20								Tier 4																							4
H2459	002	0	1	02	01	H2459_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2459	002	0	1	02	01	H2459_002_0	4	3	1	Tier 3	000010	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2459	002	0	1	02	01	H2459_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2459	006	0	1	02	01	H2459_006_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2459	006	0	1	02	01	H2459_006_0	6	3	1	Tier 3	000010	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2459	006	0	1	02	01	H2459_006_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2459	006	0	1	02	01	H2459_006_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	20	20								20				20								Tier 4																							4
H2459	013	0	1	02	01	H2459_013_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2459	013	0	1	02	01	H2459_013_0	4	3	1	Tier 3	000010	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2459	013	0	1	02	01	H2459_013_0	4	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	20	20								20				20								Tier 4																							4
H2459	013	0	1	02	01	H2459_013_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2459	014	0	1	02	01	H2459_014_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	20	20								20				20								Tier 4																							4
H2459	014	0	1	02	01	H2459_014_0	6	3	1	Tier 3	000010	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				100.00									4
H2459	014	0	1	02	01	H2459_014_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				50.00									4
H2459	014	0	1	02	01	H2459_014_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				20.00									4
H2462	005	0	1	18	06	H2462_005_0	6	2	1	Formulary Brand	000010		2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	1	2		011000000011011000000	Formulary Brand																						Formulary Brand	31.00	93.00								31.00	93.00		31.00	62.00									3
H2462	005	0	1	18	06	H2462_005_0	6	1	1	Formulary Generic	010000		2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00	30.00		10.00	20.00									3
H2462	005	0	1	18	06	H2462_005_0	6	3	1	Formulary Specialty	000010		1	Formulary Specialty	010000000010010000000	30									30			30									Formulary Specialty	2	1	010000000010010000000		Formulary Specialty	25									25			25									Formulary Specialty																							3
H2462	006	0	1	18	06	H2462_006_0	7	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00	30.00		10.00	20.00									4
H2462	006	0	1	18	06	H2462_006_0	7	2	1	Formulary Brand	000010	1	2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	1	2		011000000011011000000	Formulary Brand																						Formulary Brand	31.00	93.00								31.00	93.00		31.00	62.00									4
H2462	006	0	1	18	06	H2462_006_0	7	3	1	Formulary Specialty	000010	1	1	Formulary Specialty	010000000010010000000	30									30			30									Formulary Specialty	2	1	010000000010010000000		Formulary Specialty	25									25			25									Formulary Specialty																							4
H2462	008	0	1	18	06	H2462_008_0	5	2	1	Formulary Brand	000010		2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	1	2		011000000011011000000	Formulary Brand																						Formulary Brand	31.00	93.00								31.00	93.00		31.00	62.00									3
H2462	008	0	1	18	06	H2462_008_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00	30.00		10.00	20.00									3
H2462	008	0	1	18	06	H2462_008_0	5	3	1	Formulary Specialty	000010		1	Formulary Specialty	010000000010010000000	30									30			30									Formulary Specialty	2	1	010000000010010000000		Formulary Specialty	25									25			25									Formulary Specialty																							3
H2462	009	0	1	18	06	H2462_009_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00	30.00		10.00	20.00									4
H2462	009	0	1	18	06	H2462_009_0	4	2	1	Formulary Brand	000010	1	2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	1	2		011000000011011000000	Formulary Brand																						Formulary Brand	31.00	93.00								31.00	93.00		31.00	62.00									4
H2462	009	0	1	18	06	H2462_009_0	4	3	1	Formulary Specialty	000010	1	1	Formulary Specialty	010000000010010000000	30									30			30									Formulary Specialty	2	1	010000000010010000000		Formulary Specialty	25									25			25									Formulary Specialty																							4
H2462	011	0	1	18	06	H2462_011_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00	30.00		10.00	20.00									3
H2462	011	0	1	18	06	H2462_011_0	5	2	1	Formulary Brand	000010		2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	1	2		011000000011011000000	Formulary Brand																						Formulary Brand	31.00	93.00								31.00	93.00		31.00	62.00									3
H2462	011	0	1	18	06	H2462_011_0	5	3	1	Formulary Specialty	000010		1	Formulary Specialty	010000000010010000000	30									30			30									Formulary Specialty	2	1	010000000010010000000		Formulary Specialty	25									25			25									Formulary Specialty																							3
H2462	012	0	1	18	06	H2462_012_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00	30.00		10.00	20.00									4
H2462	012	0	1	18	06	H2462_012_0	4	2	1	Formulary Brand	000010	1	2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	1	2		011000000011011000000	Formulary Brand																						Formulary Brand	31.00	93.00								31.00	93.00		31.00	62.00									4
H2462	012	0	1	18	06	H2462_012_0	4	3	1	Formulary Specialty	000010	1	1	Formulary Specialty	010000000010010000000	30									30			30									Formulary Specialty	2	1	010000000010010000000		Formulary Specialty	25									25			25									Formulary Specialty																							4
H2610	005	0	1	01	01	H2610_005_0	6	3	1	Tier 3 Non-preferred Brand	100000	1	2	Tier 3 Non-preferred Brand	011000000010011000000	31	93								31			31	93								Tier 3 Non-preferred Brand	2	2		011000000010011000000	Tier 3 Non-preferred Brand																						Tier 3 Non-preferred Brand	59.00	177.00								59.00			59.00	177.00									4
H2610	005	0	1	01	01	H2610_005_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000010011000000	31	93								31			31	93								Tier 2 Preferred Brand	2	2		011000000010011000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	29.00	87.00								29.00			29.00	87.00									4
H2610	005	0	1	01	01	H2610_005_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000010011000000	31	93								31			31	93								Tier 1 Generic	2	2		011000000010011000000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00								5.00			5.00	15.00									4
H2610	005	0	1	01	01	H2610_005_0	6	4	1	Tier 4 Injectables	111111	1	2	Tier 4 Injectables	011000000010011000000	31	93								31			31	93								Tier 4 Injectables	2	1	011000000010011000000		Tier 4 Injectables	20	20								20			20	20								Tier 4 Injectables																							4
H2610	006	0	1	01	01	H2610_006_0	6	3	1	Tier 3 Non-preferred Brand	100000	1	2	Tier 3 Non-preferred Brand	011000000010011000000	31	93								31			31	93								Tier 3 Non-preferred Brand	2	2		011000000010011000000	Tier 3 Non-preferred Brand																						Tier 3 Non-preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H2610	006	0	1	01	01	H2610_006_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000010011000000	31	93								31			31	93								Tier 2 Preferred Brand	2	2		011000000010011000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	29.00	87.00								29.00			29.00	87.00									4
H2610	006	0	1	01	01	H2610_006_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000010011000000	31	93								31			31	93								Tier 1 Generic	2	2		011000000010011000000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00								5.00			5.00	15.00									4
H2610	006	0	1	01	01	H2610_006_0	6	4	1	Tier 4 Injectables	111111	1	2	Tier 4 Injectables	011000000010011000000	31	93								31			31	93								Tier 4 Injectables	2	1	011000000010011000000		Tier 4 Injectables	20	20								20			20	20								Tier 4 Injectables																							4
H2611	001	0	1	04	01	H2611_001_0	9	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	2.00	4.00								2.00	4.00			4.00									4
H2611	001	0	1	04	01	H2611_001_0	9	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	18.00	36.00								18.00	36.00			36.00									4
H2611	001	0	1	04	01	H2611_001_0	9	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	80.00								40.00	80.00			80.00									4
H2611	001	0	1	04	01	H2611_001_0	9	4	1	Specialty Brand	000010	1	1	Specialty Brand	010000000010000000000	30									30												Specialty Brand	2	1	010000000010000000000		Specialty Brand	20									20												Specialty Brand																							4
H2611	007	0	1	04	01	H2611_007_0	9	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	2.00	4.00								2.00	4.00			4.00									4
H2611	007	0	1	04	01	H2611_007_0	9	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	22.00	44.00								22.00	44.00			44.00									4
H2611	007	0	1	04	01	H2611_007_0	9	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00								50.00	100.00			100.00									4
H2611	007	0	1	04	01	H2611_007_0	9	4	1	Specialty Brand	000010	1	1	Specialty Brand	010000000010000000000	30									30												Specialty Brand	2	1	010000000010000000000		Specialty Brand	20									20												Specialty Brand																							4
H2613	004	0	1	09	04	H2613_004_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H2613	004	0	1	09	04	H2613_004_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H2613	004	0	1	09	04	H2613_004_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H2613	004	0	1	09	04	H2613_004_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H2613	004	0	1	09	04	H2613_004_0	7	4	1	Non-Speciality Injectables	010010	1	2	Non-Speciality Injectables	011000000010000001001	30	90								30							90			90		Non-Speciality Injectables	2	1	011000000010000001001		Non-Speciality Injectables	30	30								30							25			25		Non-Speciality Injectables																							4
H2649	004	0	1	01	01	H2649_004_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H2649	004	0	1	01	01	H2649_004_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H2649	004	0	1	01	01	H2649_004_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	55.00	165.00								55.00			55.00	137.50									4
H2649	004	0	1	01	01	H2649_004_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2649	011	0	1	01	01	H2649_011_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H2649	011	0	1	01	01	H2649_011_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H2649	011	0	1	01	01	H2649_011_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	55.00	165.00								55.00			55.00	137.50									4
H2649	011	0	1	01	01	H2649_011_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H2654	004	0	1	01	01	H2654_004_0	12	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2654	004	0	1	01	01	H2654_004_0	12	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2654	004	0	1	01	01	H2654_004_0	12	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2654	004	0	1	01	01	H2654_004_0	12	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2654	010	0	1	01	01	H2654_010_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2654	010	0	1	01	01	H2654_010_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2654	010	0	1	01	01	H2654_010_0	9	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2654	010	0	1	01	01	H2654_010_0	9	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2654	013	0	1	02	01	H2654_013_0	11	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2654	013	0	1	02	01	H2654_013_0	11	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2654	013	0	1	02	01	H2654_013_0	11	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2654	013	0	1	02	01	H2654_013_0	11	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2654	023	0	1	01	01	H2654_023_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2654	023	0	1	01	01	H2654_023_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2654	023	0	1	01	01	H2654_023_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2654	023	0	1	01	01	H2654_023_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2654	024	0	1	01	01	H2654_024_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2654	024	0	1	01	01	H2654_024_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2654	024	0	1	01	01	H2654_024_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2654	024	0	1	01	01	H2654_024_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2654	025	0	1	01	01	H2654_025_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2654	025	0	1	01	01	H2654_025_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2654	025	0	1	01	01	H2654_025_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2654	025	0	1	01	01	H2654_025_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2663	002	0	1	01	01	H2663_002_0	3	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H2663	002	0	1	01	01	H2663_002_0	3	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
H2663	002	0	1	01	01	H2663_002_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	57.00	171.00								57.00				114.00									4
H2663	002	0	1	01	01	H2663_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	78.00								26.00				52.00									4
H2663	002	0	1	01	01	H2663_002_0	3	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H2663	002	0	1	01	01	H2663_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2663	002	0	1	01	01	H2663_002_0	3	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H2663	002	0	1	01	01	H2663_002_0	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2663	005	0	1	01	01	H2663_005_0	5	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H2663	005	0	1	01	01	H2663_005_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H2663	005	0	1	01	01	H2663_005_0	5	4	1	Specialty	010010		1	Specialty	010000000010000000000	30									30												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							3
H2663	005	0	1	01	01	H2663_005_0	5	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	53.00	159.00								53.00				106.00									3
H2663	006	0	1	01	01	H2663_006_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H2663	006	0	1	01	01	H2663_006_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H2663	006	0	1	01	01	H2663_006_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	53.00	159.00								53.00				106.00									3
H2663	006	0	1	01	01	H2663_006_0	4	4	1	Specialty	010010		1	Specialty	010000000010000000000	30									30												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							3
H2663	007	0	1	01	01	H2663_007_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H2663	007	0	1	01	01	H2663_007_0	4	3	1	Non-Preferred	100100		2	Non-Preferred	011000000010001000000	30	90								30				90								Non-Preferred	2	2		011000000010001000000	Non-Preferred																						Non-Preferred	53.00	159.00								53.00				106.00									3
H2663	007	0	1	01	01	H2663_007_0	4	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00				50.00									3
H2663	007	0	1	01	01	H2663_007_0	4	4	1	Specialty	010010		1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							3
H2663	008	0	1	01	01	H2663_008_0	5	5	1	Diabetic Needs	010010	3	2	Diabetic Needs	011000000010000000000	30	90								30												Diabetic Needs	2	2		011000000010001000000	Diabetic Needs																						Diabetic Needs	0.00	0.00								0.00				0.00									4
H2663	008	0	1	01	01	H2663_008_0	5	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
H2663	008	0	1	01	01	H2663_008_0	5	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
H2663	008	0	1	01	01	H2663_008_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	78.00								26.00				52.00									4
H2663	008	0	1	01	01	H2663_008_0	5	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H2663	008	0	1	01	01	H2663_008_0	5	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H2663	008	0	1	01	01	H2663_008_0	5	5	3	Diabetic Needs	010010	3	2	Diabetic Needs	011000000010001000000	30	90								30				90								Diabetic Needs	2	2		011000000010001000000	Diabetic Needs																						Diabetic Needs	0.00	0.00								0.00				0.00								1	4
H2663	008	0	1	01	01	H2663_008_0	5	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2663	008	0	1	01	01	H2663_008_0	5	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H2663	008	0	1	01	01	H2663_008_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2663	009	0	1	01	01	H2663_009_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H2663	009	0	1	01	01	H2663_009_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	78.00								26.00				52.00									4
H2663	009	0	1	01	01	H2663_009_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
H2663	009	0	1	01	01	H2663_009_0	4	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
H2663	009	0	1	01	01	H2663_009_0	4	5	3	Diabetic Needs	010010	3	2	Diabetic Needs	011000000010001000000	30	90								30				90								Diabetic Needs	2	2		011000000010001000000	Diabetic Needs																						Diabetic Needs	0.00	0.00								0.00				0.00								1	4
H2663	009	0	1	01	01	H2663_009_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H2663	009	0	1	01	01	H2663_009_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2663	009	0	1	01	01	H2663_009_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H2663	009	0	1	01	01	H2663_009_0	4	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2663	009	0	1	01	01	H2663_009_0	4	5	1	Diabetic Needs	010010	3	2	Diabetic Needs	011000000010000000000	30	90								30												Diabetic Needs	2	2		011000000010001000000	Diabetic Needs																						Diabetic Needs	0.00	0.00								0.00				0.00									4
H2667	003	0	1	01	01	H2667_003_0	7	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	2.00	4.00								2.00	4.00			4.00									4
H2667	003	0	1	01	01	H2667_003_0	7	4	1	Specialty Brand	000010	1	1	Specialty Brand	010000000010000000000	30									30												Specialty Brand	2	1	010000000010000000000		Specialty Brand	20									20												Specialty Brand																							4
H2667	003	0	1	01	01	H2667_003_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00								50.00	100.00			100.00									4
H2667	003	0	1	01	01	H2667_003_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	20.00	40.00								20.00	40.00			40.00									4
H2667	005	0	1	01	01	H2667_005_0	6	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	2.00	4.00								2.00	4.00			4.00									4
H2667	005	0	1	01	01	H2667_005_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	17.00	34.00								17.00	34.00			34.00									4
H2667	005	0	1	01	01	H2667_005_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00								50.00	100.00			100.00									4
H2667	005	0	1	01	01	H2667_005_0	6	4	1	Specialty Brand	000010	1	1	Specialty Brand	010000000010000000000	30									30												Specialty Brand	2	1	010000000010000000000		Specialty Brand	20									20												Specialty Brand																							4
H2667	015	0	1	01	01	H2667_015_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00								50.00	100.00			100.00									4
H2667	015	0	1	01	01	H2667_015_0	7	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	2.00	4.00								2.00	4.00			4.00									4
H2667	015	0	1	01	01	H2667_015_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	22.00	44.00								22.00	44.00			44.00									4
H2667	015	0	1	01	01	H2667_015_0	7	4	1	Specialty Brand	000010	1	1	Specialty Brand	010000000010000000000	30									30												Specialty Brand	2	1	010000000010000000000		Specialty Brand	20									20												Specialty Brand																							4
H2672	001	0	1	01	01	H2672_001_0	6	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									4
H2672	001	0	1	01	01	H2672_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H2672	001	0	1	01	01	H2672_001_0	6	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00				100.00									4
H2672	001	0	1	01	01	H2672_001_0	6	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H2672	001	0	1	01	01	H2672_001_0	6	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00								1	4
H2672	001	0	1	01	01	H2672_001_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2672	001	0	1	01	01	H2672_001_0	6	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H2672	001	0	1	01	01	H2672_001_0	6	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H2672	003	0	1	01	01	H2672_003_0	5	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									4
H2672	003	0	1	01	01	H2672_003_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H2672	003	0	1	01	01	H2672_003_0	5	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H2672	003	0	1	01	01	H2672_003_0	5	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H2672	003	0	1	01	01	H2672_003_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H2672	003	0	1	01	01	H2672_003_0	5	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00				100.00									4
H2672	003	0	1	01	01	H2672_003_0	5	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H2672	003	0	1	01	01	H2672_003_0	5	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00								1	4
H2672	007	0	1	01	01	H2672_007_0	8	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00				100.00									4
H2672	007	0	1	01	01	H2672_007_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H2672	007	0	1	01	01	H2672_007_0	8	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									4
H2672	007	0	1	01	01	H2672_007_0	8	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H2701	001	0	1	04	01	H2701_001_0	6	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	34	90								34				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				30.00									4
H2701	001	0	1	04	01	H2701_001_0	6	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	34	90								34				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00				75.00									4
H2701	001	0	1	04	01	H2701_001_0	6	4	3	Specialty	010011	3	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2701	001	0	1	04	01	H2701_001_0	6	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H2701	001	0	1	04	01	H2701_001_0	6	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H2701	001	0	1	04	01	H2701_001_0	6	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	34	90								34				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				30.00								1	4
H2701	001	0	1	04	01	H2701_001_0	6	4	1	Specialty	010011	3	1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	2		011000000010001000000	Specialty																						Specialty	50.00	150.00								50.00				150.00									4
H2701	001	0	1	04	01	H2701_001_0	6	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010001000000	34	90								34				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	50.00	150.00								50.00				150.00									4
H2701	003	0	1	04	01	H2701_003_0	8	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	34	90								34				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				30.00									4
H2701	003	0	1	04	01	H2701_003_0	8	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H2701	003	0	1	04	01	H2701_003_0	8	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H2701	003	0	1	04	01	H2701_003_0	8	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	34	90								34				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				30.00								1	4
H2701	003	0	1	04	01	H2701_003_0	8	4	1	Specialty	010011	3	1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	2		011000000010001000000	Specialty																						Specialty	50.00	150.00								50.00				150.00									4
H2701	003	0	1	04	01	H2701_003_0	8	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010001000000	34	90								34				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	50.00	150.00								50.00				150.00									4
H2701	003	0	1	04	01	H2701_003_0	8	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	34	90								34				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00				75.00									4
H2701	003	0	1	04	01	H2701_003_0	8	4	3	Specialty	010011	3	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H2802	001	0	1	01	01	H2802_001_0	13	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2802	001	0	1	01	01	H2802_001_0	13	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2802	001	0	1	01	01	H2802_001_0	13	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2802	001	0	1	01	01	H2802_001_0	13	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2802	005	0	1	01	01	H2802_005_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2802	005	0	1	01	01	H2802_005_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2802	005	0	1	01	01	H2802_005_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2802	005	0	1	01	01	H2802_005_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2803	001	0	1	02	01	H2803_001_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2803	001	0	1	02	01	H2803_001_0	9	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2803	001	0	1	02	01	H2803_001_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2803	001	0	1	02	01	H2803_001_0	9	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2803	002	0	1	02	01	H2803_002_0	12	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H2803	002	0	1	02	01	H2803_002_0	12	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2803	002	0	1	02	01	H2803_002_0	12	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2803	002	0	1	02	01	H2803_002_0	12	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H2803	010	0	1	02	01	H2803_010_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2803	010	0	1	02	01	H2803_010_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2803	010	0	1	02	01	H2803_010_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2803	010	0	1	02	01	H2803_010_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2803	011	0	1	02	01	H2803_011_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2803	011	0	1	02	01	H2803_011_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H2803	011	0	1	02	01	H2803_011_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2803	011	0	1	02	01	H2803_011_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2803	012	0	1	02	01	H2803_012_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H2803	012	0	1	02	01	H2803_012_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H2803	012	0	1	02	01	H2803_012_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H2803	012	0	1	02	01	H2803_012_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H2905	001	0	1	04	01	H2905_001_0	6	3	1	Specialty Tier	010010		1	Specialty Tier	011000000010001000000	30	90								30				90								Specialty Tier	2	1	011000000010001000000		Specialty Tier	25	25								25				25								Specialty Tier																							3
H2905	001	0	1	04	01	H2905_001_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00				60.00									3
H2905	001	0	1	04	01	H2905_001_0	6	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H2906	003	0	1	04	01	H2906_003_0	5	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	15.00								6.00				15.00									4
H2906	003	0	1	04	01	H2906_003_0	5	4	1	Special Pharmaceutical	000001	1	1	Special Pharmaceutical	011000000010001000000	30	90								30				90								Special Pharmaceutical	2	2		011000000010001000000	Special Pharmaceutical																						Special Pharmaceutical	100.00	250.00								100.00				250.00									4
H2906	003	0	1	04	01	H2906_003_0	5	3	1	Non- Preferred Brand Name	100000	1	2	Non- Preferred Brand Name	011000000010001000000	30	90								30				90								Non- Preferred Brand Name	2	2		011000000010001000000	Non- Preferred Brand Name																						Non- Preferred Brand Name	65.00	162.50								65.00				162.50									4
H2906	003	0	1	04	01	H2906_003_0	5	2	1	Preferred Brand Name	000001	1	2	Preferred Brand Name	011000000010001000000	30	90								30				90								Preferred Brand Name	2	2		011000000010001000000	Preferred Brand Name																						Preferred Brand Name	40.00	100.00								40.00				100.00									4
H2931	002	0	1	02	01	H2931_002_0	3	1	1	Preferred Generic	001000	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	3.00	9.00								3.00				3.00									4
H2931	002	0	1	02	01	H2931_002_0	3	3	1	Non-preferred Generic	000100	1	2	Non-preferred Generic	010000000010000000000	30									30												Non-preferred Generic	2	2		010000000010000000000	Non-preferred Generic																						Non-preferred Generic	55.00									55.00													4
H2931	002	0	1	02	01	H2931_002_0	3	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				60.00									4
H2931	002	0	1	02	01	H2931_002_0	3	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							4
H2931	002	0	1	02	01	H2931_002_0	3	4	1	Non-preferred Brand	100000	1	2	Non-preferred Brand	010000000010000000000	30									30												Non-preferred Brand	2	2		010000000010000000000	Non-preferred Brand																						Non-preferred Brand	55.00									55.00													4
H2931	004	0	1	01	01	H2931_004_0	4	3	1	Non-preferred Generic	000100		2	Non-preferred Generic	010000000010000000000	30									30												Non-preferred Generic	2	2		010000000010000000000	Non-preferred Generic																						Non-preferred Generic	55.00									55.00													3
H2931	004	0	1	01	01	H2931_004_0	4	5	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							3
H2931	004	0	1	01	01	H2931_004_0	4	4	1	Non-preferred Brand	100000		2	Non-preferred Brand	010000000010000000000	30									30												Non-preferred Brand	2	2		010000000010000000000	Non-preferred Brand																						Non-preferred Brand	55.00									55.00													3
H2931	004	0	1	01	01	H2931_004_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				60.00									3
H2931	004	0	1	01	01	H2931_004_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				7.00									3
H2931	006	0	1	02	01	H2931_006_0	3	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				60.00									4
H2931	006	0	1	02	01	H2931_006_0	3	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							4
H2931	006	0	1	02	01	H2931_006_0	3	4	1	Non-preferred Brand	100000	1	2	Non-preferred Brand	010000000010000000000	30									30												Non-preferred Brand	2	2		010000000010000000000	Non-preferred Brand																						Non-preferred Brand	55.00									55.00													4
H2931	006	0	1	02	01	H2931_006_0	3	3	1	Non-preferred Generic	000100	1	2	Non-preferred Generic	010000000010000000000	30									30												Non-preferred Generic	2	2		010000000010000000000	Non-preferred Generic																						Non-preferred Generic	55.00									55.00													4
H2931	006	0	1	02	01	H2931_006_0	3	1	1	Preferred Generic	001000	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	3.00	9.00								3.00				3.00									4
H2931	015	0	1	01	01	H2931_015_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				60.00									4
H2931	015	0	1	01	01	H2931_015_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				7.00									4
H2931	015	0	1	01	01	H2931_015_0	4	4	1	Non-preferred Brand	100000	1	2	Non-preferred Brand	010000000010000000000	30									30												Non-preferred Brand	2	2		010000000010000000000	Non-preferred Brand																						Non-preferred Brand	55.00									55.00													4
H2931	015	0	1	01	01	H2931_015_0	4	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							4
H2931	015	0	1	01	01	H2931_015_0	4	3	1	Non-preferred Generic	000100	1	2	Non-preferred Generic	010000000010000000000	30									30												Non-preferred Generic	2	2		010000000010000000000	Non-preferred Generic																						Non-preferred Generic	55.00									55.00													4
H2949	002	0	1	01	01	H2949_002_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H2949	002	0	1	01	01	H2949_002_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H2949	002	0	1	01	01	H2949_002_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H2949	002	0	1	01	01	H2949_002_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H2949	007	0	1	01	01	H2949_007_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H2949	007	0	1	01	01	H2949_007_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H2949	007	0	1	01	01	H2949_007_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H2949	007	0	1	01	01	H2949_007_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H2949	012	0	1	01	01	H2949_012_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H2949	012	0	1	01	01	H2949_012_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H2949	012	0	1	01	01	H2949_012_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H2949	012	0	1	01	01	H2949_012_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H2960	004	0	1	01	01	H2960_004_0	9	2	3	Preferred Brand Name	000001	1	2	Preferred Brand Name																							Preferred Brand Name					Preferred Brand Name																						Preferred Brand Name																						2	4
H2960	004	0	1	01	01	H2960_004_0	9	3	3	Non-Preferred Brand Name	100000	1	2	Non-Preferred Brand Name																							Non-Preferred Brand Name					Non-Preferred Brand Name																						Non-Preferred Brand Name																						2	4
H2960	004	0	1	01	01	H2960_004_0	9	4	3	Special Pharmaceutical	000001	1	1	Special Pharmaceutical																							Special Pharmaceutical					Special Pharmaceutical																						Special Pharmaceutical																						2	4
H2960	004	0	1	01	01	H2960_004_0	9	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	15.00								6.00				15.00									4
H2960	004	0	1	01	01	H2960_004_0	9	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	15.00								6.00				15.00								1	4
H2960	004	0	1	01	01	H2960_004_0	9	4	1	Special Pharmaceutical	000001	1	1	Special Pharmaceutical	011000000010001000000	30	90								30				90								Special Pharmaceutical	2	2		011000000010001000000	Special Pharmaceutical																						Special Pharmaceutical	100.00	250.00								100.00				250.00									4
H2960	004	0	1	01	01	H2960_004_0	9	3	1	Non-Preferred Brand Name	100000	1	2	Non-Preferred Brand Name	011000000010001000000	30	90								30				90								Non-Preferred Brand Name	2	2		011000000010001000000	Non-Preferred Brand Name																						Non-Preferred Brand Name	65.00	162.50								65.00				162.50									4
H2960	004	0	1	01	01	H2960_004_0	9	2	1	Preferred Brand Name	000001	1	2	Preferred Brand Name	011000000010001000000	30	90								30				90								Preferred Brand Name	2	2		011000000010001000000	Preferred Brand Name																						Preferred Brand Name	40.00	100.00								40.00				100.00									4
H2960	010	0	1	01	01	H2960_010_0	9	3	1	Non- Preferred Brand Name Drugs	100000	1	2	Non- Preferred Brand Name Drugs	011000000010001000000	30	90								30				90								Non- Preferred Brand Name Drugs	2	2		011000000010001000000	Non- Preferred Brand Name Drugs																						Non- Preferred Brand Name Drugs	65.00	162.50								65.00				162.50									4
H2960	010	0	1	01	01	H2960_010_0	9	4	1	Special Pharmaceuticals	000001	1	1	Special Pharmaceuticals	011000000010001000000	30	90								30				90								Special Pharmaceuticals	2	2		011000000010001000000	Special Pharmaceuticals																						Special Pharmaceuticals	100.00	250.00								100.00				250.00									4
H2960	010	0	1	01	01	H2960_010_0	9	2	1	Preferred Brand Name Drugs	000001	1	2	Preferred Brand Name Drugs	011000000010001000000	30	90								30				90								Preferred Brand Name Drugs	2	2		011000000010001000000	Preferred Brand Name Drugs																						Preferred Brand Name Drugs	40.00	100.00								40.00				100.00									4
H2960	010	0	1	01	01	H2960_010_0	9	1	1	Generic Drugs	010000	1	2	Generic Drugs	011000000010001000000	30	90								30				90								Generic Drugs	2	2		011000000010001000000	Generic Drugs																						Generic Drugs	6.00	15.00								6.00				15.00									4
H2961	002	0	1	10	05	H2961_002_0	6	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							4
H2961	002	0	1	10	05	H2961_002_0	6	3	1	Non-preferred Generic	000100	1	2	Non-preferred Generic	010000000010000000000	30									30												Non-preferred Generic	2	2		010000000010000000000	Non-preferred Generic																						Non-preferred Generic	55.00									55.00													4
H2961	002	0	1	10	05	H2961_002_0	6	1	1	Preferred Generic	001000	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	3.00	9.00								3.00				3.00									4
H2961	002	0	1	10	05	H2961_002_0	6	4	1	Non-preferred Brand	100000	1	2	Non-preferred Brand	010000000010000000000	30									30												Non-preferred Brand	2	2		010000000010000000000	Non-preferred Brand																						Non-preferred Brand	55.00									55.00													4
H2961	002	0	1	10	05	H2961_002_0	6	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				30.00									4
H2961	011	0	1	10	05	H2961_011_0	5	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							4
H2961	011	0	1	10	05	H2961_011_0	5	1	1	Preferred Generic	001000	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	3.00	9.00								3.00				3.00									4
H2961	011	0	1	10	05	H2961_011_0	5	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H2961	011	0	1	10	05	H2961_011_0	5	3	1	Non-preferred Generic	000100	1	2	Non-preferred Generic	010000000010000000000	30									30												Non-preferred Generic	2	2		010000000010000000000	Non-preferred Generic																						Non-preferred Generic	55.00									55.00													4
H2961	011	0	1	10	05	H2961_011_0	5	4	1	Non-preferred Brand	100000	1	2	Non-preferred Brand	010000000010000000000	30									30												Non-preferred Brand	2	2		010000000010000000000	Non-preferred Brand																						Non-preferred Brand	55.00									55.00													4
H3107	004	0	1	01	01	H3107_004_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3107	004	0	1	01	01	H3107_004_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3107	004	0	1	01	01	H3107_004_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3107	004	0	1	01	01	H3107_004_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3107	005	0	1	01	01	H3107_005_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3107	005	0	1	01	01	H3107_005_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3107	005	0	1	01	01	H3107_005_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3107	005	0	1	01	01	H3107_005_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3107	006	0	1	01	01	H3107_006_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3107	006	0	1	01	01	H3107_006_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3107	006	0	1	01	01	H3107_006_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3107	006	0	1	01	01	H3107_006_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3107	009	0	1	01	01	H3107_009_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3107	009	0	1	01	01	H3107_009_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3107	009	0	1	01	01	H3107_009_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3107	009	0	1	01	01	H3107_009_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3112	001	0	1	01	01	H3112_001_0	6	4	1	Tier 4 - Specialty	110001		1	Tier 4 - Specialty	010000000010010000000	31									31			31									Tier 4 - Specialty	2	1	010000000010010000000		Tier 4 - Specialty	25									25			25									Tier 4 - Specialty																							3
H3112	001	0	1	01	01	H3112_001_0	6	3	1	Tier 3 - Non-Preferred Brand	100000		2	Tier 3 - Non-Preferred Brand	010000000010010000000	31									31			31									Tier 3 - Non-Preferred Brand	2	2		010000000010010000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	75.00									75.00			75.00										3
H3112	001	0	1	01	01	H3112_001_0	6	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	010000000010010000000	31									31			31									Tier 1 - Generic	2	2		010000000010010000000	Tier 1 - Generic																						Tier 1 - Generic	0.00									0.00			0.00										3
H3112	001	0	1	01	01	H3112_001_0	6	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	010000000010010000000	31									31			31									Tier 2 - Preferred Brand	2	2		010000000010010000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	40.00									40.00			40.00										3
H3113	001	0	1	01	01	H3113_001_0	5	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H3113	001	0	1	01	01	H3113_001_0	5	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H3113	001	0	1	01	01	H3113_001_0	5	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H3113	001	0	1	01	01	H3113_001_0	5	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H3152	022	0	1	01	01	H3152_022_0	4	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3152	022	0	1	01	01	H3152_022_0	4	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				39.00	97.50		39.00	117.00		78.00							78.00			117.00			3
H3152	022	0	1	01	01	H3152_022_0	4	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H3152	044	0	1	01	01	H3152_044_0	6	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H3152	044	0	1	01	01	H3152_044_0	6	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H3152	044	0	1	01	01	H3152_044_0	6	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3152	046	0	1	01	01	H3152_046_0	4	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H3152	046	0	1	01	01	H3152_046_0	4	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H3152	046	0	1	01	01	H3152_046_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H3152	046	0	1	01	01	H3152_046_0	4	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3152	046	0	1	01	01	H3152_046_0	4	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3152	046	0	1	01	01	H3152_046_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H3152	047	0	1	01	01	H3152_047_0	5	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3152	047	0	1	01	01	H3152_047_0	5	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
H3152	047	0	1	01	01	H3152_047_0	5	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3152	047	0	1	01	01	H3152_047_0	5	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
H3152	048	0	1	01	01	H3152_048_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3152	048	0	1	01	01	H3152_048_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H3152	048	0	1	01	01	H3152_048_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H3152	048	0	1	01	01	H3152_048_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3152	048	0	1	01	01	H3152_048_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3152	048	0	1	01	01	H3152_048_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H3152	048	0	1	01	01	H3152_048_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3152	048	0	1	01	01	H3152_048_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3152	053	0	1	01	01	H3152_053_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3152	053	0	1	01	01	H3152_053_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3152	053	0	1	01	01	H3152_053_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3152	053	0	1	01	01	H3152_053_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H3152	053	0	1	01	01	H3152_053_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3152	053	0	1	01	01	H3152_053_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H3152	053	0	1	01	01	H3152_053_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H3152	053	0	1	01	01	H3152_053_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3154	004	0	1	01	01	H3154_004_0	12	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									2
H3154	004	0	1	01	01	H3154_004_0	12	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00	66.00			66.00									2
H3154	004	0	1	01	01	H3154_004_0	12	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00								44.00	132.00			132.00									2
H3154	004	0	1	01	01	H3154_004_0	12	4	1	Specialty	010011		1	Specialty	011000000011000000000	30	90								30	90											Specialty	1	1	011000000011000000000		Specialty	25	25								25	25											Specialty																							2
H3154	006	0	1	02	01	H3154_006_0	10	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	10.00	30.00								10.00	30.00			30.00								1	4
H3154	006	0	1	02	01	H3154_006_0	10	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3154	006	0	1	02	01	H3154_006_0	10	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3154	006	0	1	02	01	H3154_006_0	10	4	3	Specialty	010011	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H3154	006	0	1	02	01	H3154_006_0	10	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	10.00	30.00								10.00	30.00			30.00									4
H3154	006	0	1	02	01	H3154_006_0	10	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00			60.00									4
H3154	006	0	1	02	01	H3154_006_0	10	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	39.00	117.00								39.00	117.00			117.00									4
H3154	006	0	1	02	01	H3154_006_0	10	4	1	Specialty	010011	1	1	Specialty	011000000011000000000	30	90								30	90											Specialty	1	1	011000000011000000000		Specialty	25	25								25	25											Specialty																							4
H3156	021	0	1	02	01	H3156_021_0	8	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	011000000011001000000	30	90								30	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	15.00								5.00	15.00			10.00									3
H3156	021	0	1	02	01	H3156_021_0	8	3	1	Tier 3 - Non-Preferred Brand	100000		2	Tier 3 - Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	150.00								50.00	150.00			100.00									3
H3156	021	0	1	02	01	H3156_021_0	8	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	011000000011001000000	30	90								30	90			90								Tier 2 - Preferred Brand	2	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	30.00	90.00								30.00	90.00			60.00									3
H3204	001	0	1	01	01	H3204_001_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011001000000	30	90								30	90			90								Preferred Generic	2	2		011000000011001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00	12.00			8.00									4
H3204	001	0	1	01	01	H3204_001_0	4	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	1	2		010000000010000000000	Specialty																						Specialty	100.00									100.00													4
H3204	001	0	1	01	01	H3204_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			83.00									4
H3204	001	0	1	01	01	H3204_001_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	011000000011001000000	30	90								30	90			90								Non-Preferred	1	2		011000000011001000000	Non-Preferred																						Non-Preferred	55.00	165.00								55.00	165.00			165.00									4
H3204	007	0	1	01	01	H3204_007_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	011000000011001000000	30	90								30	90			90								Non-Preferred	1	2		011000000011001000000	Non-Preferred																						Non-Preferred	55.00	165.00								55.00	165.00			165.00									4
H3204	007	0	1	01	01	H3204_007_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			83.00									4
H3204	007	0	1	01	01	H3204_007_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011001000000	30	90								30	90			90								Preferred Generic	2	2		011000000011001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00	12.00			8.00									4
H3204	007	0	1	01	01	H3204_007_0	4	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	1	2		010000000010000000000	Specialty																						Specialty	100.00									100.00													4
H3204	007	0	1	01	01	H3204_007_0	4	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000011001000000	30	90								30	90			90								Preferred Generic	2	2		011000000011001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00	12.00			8.00								1	4
H3204	007	0	1	01	01	H3204_007_0	4	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H3204	007	0	1	01	01	H3204_007_0	4	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H3204	007	0	1	01	01	H3204_007_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3206	001	0	1	04	01	H3206_001_0	4	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	1	2		010000000010000000000	Specialty																						Specialty	100.00									100.00													4
H3206	001	0	1	04	01	H3206_001_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	011000000011001000000	30	90								30	90			90								Non-Preferred	1	2		011000000011001000000	Non-Preferred																						Non-Preferred	55.00	165.00								55.00	165.00			165.00									4
H3206	001	0	1	04	01	H3206_001_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011001000000	30	90								30	90			90								Preferred Generic	2	2		011000000011001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00	12.00			8.00									4
H3206	001	0	1	04	01	H3206_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			83.00									4
H3206	002	0	1	04	01	H3206_002_0	4	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H3206	002	0	1	04	01	H3206_002_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3206	002	0	1	04	01	H3206_002_0	4	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000011001000000	30	90								30	90			90								Preferred Generic	2	2		011000000011001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00	12.00			8.00								1	4
H3206	002	0	1	04	01	H3206_002_0	4	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	1	2		010000000010000000000	Specialty																						Specialty	100.00									100.00													4
H3206	002	0	1	04	01	H3206_002_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	011000000011001000000	30	90								30	90			90								Non-Preferred	1	2		011000000011001000000	Non-Preferred																						Non-Preferred	55.00	165.00								55.00	165.00			165.00									4
H3206	002	0	1	04	01	H3206_002_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			83.00									4
H3206	002	0	1	04	01	H3206_002_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011001000000	30	90								30	90			90								Preferred Generic	2	2		011000000011001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00	12.00			8.00									4
H3206	002	0	1	04	01	H3206_002_0	4	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H3207	001	0	1	04	01	H3207_001_0	6	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									3
H3207	001	0	1	04	01	H3207_001_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				105.00									3
H3207	001	0	1	04	01	H3207_001_0	6	3	1	Non Preferred	100100		2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	66.00	198.00								66.00				198.00									3
H3207	001	0	1	04	01	H3207_001_0	6	4	1	Specialty Drug	111111		1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	33	33								33												Specialty Drug																							3
H3207	002	0	1	04	01	H3207_002_0	6	3	1	Non Preferred	100100		2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	66.00	198.00								66.00				198.00									3
H3207	002	0	1	04	01	H3207_002_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				105.00									3
H3207	002	0	1	04	01	H3207_002_0	6	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									3
H3207	002	0	1	04	01	H3207_002_0	6	4	1	Specialty Drug	111111		1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	33	33								33												Specialty Drug																							3
H3207	003	0	1	04	01	H3207_003_0	7	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00								1	4
H3207	003	0	1	04	01	H3207_003_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				105.00								1	4
H3207	003	0	1	04	01	H3207_003_0	7	3	3	Non Preferred	100100	1	2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	66.00	198.00								66.00				198.00								1	4
H3207	003	0	1	04	01	H3207_003_0	7	4	1	Specialty Drug	111111	1	1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	33	33								33												Specialty Drug																							4
H3207	003	0	1	04	01	H3207_003_0	7	3	1	Non Preferred	100100	1	2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	66.00	198.00								66.00				198.00									4
H3207	003	0	1	04	01	H3207_003_0	7	4	3	Specialty Drug	111111	1	1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	33	33								33												Specialty Drug																						1	4
H3207	003	0	1	04	01	H3207_003_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
H3207	003	0	1	04	01	H3207_003_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				105.00									4
H3207	004	0	1	04	01	H3207_004_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
H3207	004	0	1	04	01	H3207_004_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				105.00									4
H3207	004	0	1	04	01	H3207_004_0	7	4	3	Specialty Drug	111111	1	1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	33	33								33												Specialty Drug																						1	4
H3207	004	0	1	04	01	H3207_004_0	7	3	3	Non Preferred	100100	1	2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	66.00	198.00								66.00				198.00								1	4
H3207	004	0	1	04	01	H3207_004_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				105.00								1	4
H3207	004	0	1	04	01	H3207_004_0	7	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00								1	4
H3207	004	0	1	04	01	H3207_004_0	7	4	1	Specialty Drug	111111	1	1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	33	33								33												Specialty Drug																							4
H3207	004	0	1	04	01	H3207_004_0	7	3	1	Non Preferred	100100	1	2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	66.00	198.00								66.00				198.00									4
H3208	001	0	1	04	01	H3208_001_0	5	1	1	Generic	010000		2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00									3
H3208	001	0	1	04	01	H3208_001_0	5	4	1	Specialty	010010		1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							3
H3208	001	0	1	04	01	H3208_001_0	5	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-preferred Brand	2	2		000011011010001000000	Non-preferred Brand																						Non-preferred Brand				60.00	120.00		60.00	180.00		60.00				120.00									3
H3208	001	0	1	04	01	H3208_001_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				40.00	80.00		40.00	120.00		40.00				80.00									3
H3209	001	0	1	04	01	H3209_001_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			4
H3209	001	0	1	04	01	H3209_001_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3209	001	0	1	04	01	H3209_001_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3209	001	0	1	04	01	H3209_001_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3209	002	0	1	04	01	H3209_002_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3209	002	0	1	04	01	H3209_002_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3209	002	0	1	04	01	H3209_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H3209	002	0	1	04	01	H3209_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3251	002	0	1	01	01	H3251_002_0	3	4	1	Specialty Drug	111111	1	1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	25	25								25												Specialty Drug																							4
H3251	002	0	1	01	01	H3251_002_0	3	3	1	Non Preferred	100100	1	2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	62.00	186.00								62.00				186.00									4
H3251	002	0	1	01	01	H3251_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00				96.00									4
H3251	002	0	1	01	01	H3251_002_0	3	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00								1	4
H3251	002	0	1	01	01	H3251_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3251	002	0	1	01	01	H3251_002_0	3	3	3	Non Preferred	100100	1	2	Non Preferred																							Non Preferred					Non Preferred																						Non Preferred																						2	4
H3251	002	0	1	01	01	H3251_002_0	3	4	3	Specialty Drug	111111	1	1	Specialty Drug																							Specialty Drug					Specialty Drug																						Specialty Drug																						2	4
H3251	002	0	1	01	01	H3251_002_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
H3251	018	0	1	01	01	H3251_018_0	2	4	1	Specialty Drug	111111		1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	25	25								25												Specialty Drug																							3
H3251	018	0	1	01	01	H3251_018_0	2	3	1	Non Preferred	100100		2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	62.00	186.00								62.00				186.00									3
H3251	018	0	1	01	01	H3251_018_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									3
H3251	018	0	1	01	01	H3251_018_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00				96.00									3
H3251	021	0	1	01	01	H3251_021_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									4
H3251	021	0	1	01	01	H3251_021_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				60.00									4
H3251	021	0	1	01	01	H3251_021_0	3	3	1	Non Preferred	100100	1	2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	45.00	135.00								45.00				135.00									4
H3251	021	0	1	01	01	H3251_021_0	3	4	1	Specialty Drug	111111	1	1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	25	25								25												Specialty Drug																							4
H3251	021	0	1	01	01	H3251_021_0	3	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00								1	4
H3251	021	0	1	01	01	H3251_021_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				60.00								1	4
H3251	021	0	1	01	01	H3251_021_0	3	3	3	Non Preferred	100100	1	2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	45.00	135.00								45.00				135.00								1	4
H3251	021	0	1	01	01	H3251_021_0	3	4	3	Specialty Drug	111111	1	1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	25	25								25												Specialty Drug																						1	4
H3251	022	0	1	01	01	H3251_022_0	2	4	3	Specialty Drug	111111	1	1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	25	25								25												Specialty Drug																						1	4
H3251	022	0	1	01	01	H3251_022_0	2	3	3	Non Preferred	100100	1	2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	45.00	135.00								45.00				135.00								1	4
H3251	022	0	1	01	01	H3251_022_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				60.00								1	4
H3251	022	0	1	01	01	H3251_022_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00								1	4
H3251	022	0	1	01	01	H3251_022_0	2	4	1	Specialty Drug	111111	1	1	Specialty Drug	011000000010000000000	30	90								30												Specialty Drug	2	1	011000000010000000000		Specialty Drug	25	25								25												Specialty Drug																							4
H3251	022	0	1	01	01	H3251_022_0	2	3	1	Non Preferred	100100	1	2	Non Preferred	011000000010001000000	30	90								30				90								Non Preferred	2	2		011000000010001000000	Non Preferred																						Non Preferred	45.00	135.00								45.00				135.00									4
H3251	022	0	1	01	01	H3251_022_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									4
H3251	022	0	1	01	01	H3251_022_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				60.00									4
H3305	011	0	1	01	01	H3305_011_0	6	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	34	90								34	90		34	90								Tier 1	1	2		011000000011011000000	Tier 1																						Tier 1	8.00	24.00								8.00	24.00		16.00	16.00									3
H3305	011	0	1	01	01	H3305_011_0	6	2	1	Tier 2	000010		1	Tier 2	011000000011011000000	34	90								34	90		34	90								Tier 2	1	2		011000000011011000000	Tier 2																						Tier 2	40.00	120.00								40.00	120.00		80.00	80.00									3
H3305	011	0	1	01	01	H3305_011_0	6	3	1	Tier 3	000010		1	Tier 3	011000000011011000000	34	90								34	90		34	90								Tier 3	1	1	011000000011011000000		Tier 3	25	25								25	25		25	25								Tier 3																							3
H3307	002	0	1	01	01	H3307_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3307	002	0	1	01	01	H3307_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3307	002	0	1	01	01	H3307_002_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3307	002	0	1	01	01	H3307_002_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3307	011	0	1	01	01	H3307_011_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3307	011	0	1	01	01	H3307_011_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3307	011	0	1	01	01	H3307_011_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3307	011	0	1	01	01	H3307_011_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3307	012	0	1	01	01	H3307_012_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3307	012	0	1	01	01	H3307_012_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3307	012	0	1	01	01	H3307_012_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3307	012	0	1	01	01	H3307_012_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3307	013	0	1	01	01	H3307_013_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3307	013	0	1	01	01	H3307_013_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3307	013	0	1	01	01	H3307_013_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3307	013	0	1	01	01	H3307_013_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3307	015	0	1	01	01	H3307_015_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3307	015	0	1	01	01	H3307_015_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3307	015	0	1	01	01	H3307_015_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3307	015	0	1	01	01	H3307_015_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3307	020	0	1	01	01	H3307_020_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3307	020	0	1	01	01	H3307_020_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3307	020	0	1	01	01	H3307_020_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H3307	020	0	1	01	01	H3307_020_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3312	002	0	1	01	01	H3312_002_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H3312	002	0	1	01	01	H3312_002_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				12.00	30.00		12.00	36.00		22.00							24.00			36.00			3
H3312	002	0	1	01	01	H3312_002_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3312	018	0	1	01	01	H3312_018_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H3312	018	0	1	01	01	H3312_018_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				12.00	30.00		12.00	36.00		22.00							24.00			36.00			3
H3312	018	0	1	01	01	H3312_018_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3312	025	0	1	01	01	H3312_025_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H3312	025	0	1	01	01	H3312_025_0	4	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H3312	025	0	1	01	01	H3312_025_0	4	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H3312	025	0	1	01	01	H3312_025_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H3312	025	0	1	01	01	H3312_025_0	4	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3312	025	0	1	01	01	H3312_025_0	4	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3312	028	0	1	01	01	H3312_028_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H3312	028	0	1	01	01	H3312_028_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3312	028	0	1	01	01	H3312_028_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H3312	028	0	1	01	01	H3312_028_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3312	028	0	1	01	01	H3312_028_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3312	028	0	1	01	01	H3312_028_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3312	028	0	1	01	01	H3312_028_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H3312	028	0	1	01	01	H3312_028_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3312	037	0	1	01	01	H3312_037_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H3312	037	0	1	01	01	H3312_037_0	4	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3312	037	0	1	01	01	H3312_037_0	4	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H3312	037	0	1	01	01	H3312_037_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H3312	037	0	1	01	01	H3312_037_0	4	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H3312	037	0	1	01	01	H3312_037_0	4	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3312	043	0	1	01	01	H3312_043_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3312	043	0	1	01	01	H3312_043_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H3312	043	0	1	01	01	H3312_043_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H3312	044	0	1	01	01	H3312_044_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H3312	044	0	1	01	01	H3312_044_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3312	044	0	1	01	01	H3312_044_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H3312	044	0	1	01	01	H3312_044_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3312	044	0	1	01	01	H3312_044_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3312	044	0	1	01	01	H3312_044_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3312	044	0	1	01	01	H3312_044_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H3312	044	0	1	01	01	H3312_044_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3312	045	0	1	01	01	H3312_045_0	4	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H3312	045	0	1	01	01	H3312_045_0	4	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3312	045	0	1	01	01	H3312_045_0	4	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H3312	046	0	1	01	01	H3312_046_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H3312	046	0	1	01	01	H3312_046_0	4	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3312	046	0	1	01	01	H3312_046_0	4	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H3312	046	0	1	01	01	H3312_046_0	4	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3312	046	0	1	01	01	H3312_046_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H3312	046	0	1	01	01	H3312_046_0	4	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H3312	047	0	1	01	01	H3312_047_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H3312	047	0	1	01	01	H3312_047_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H3312	047	0	1	01	01	H3312_047_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3312	047	0	1	01	01	H3312_047_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3312	047	0	1	01	01	H3312_047_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3312	047	0	1	01	01	H3312_047_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3312	047	0	1	01	01	H3312_047_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3312	047	0	1	01	01	H3312_047_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H3312	048	0	1	01	01	H3312_048_0	4	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H3312	048	0	1	01	01	H3312_048_0	4	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H3312	048	0	1	01	01	H3312_048_0	4	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3312	049	0	1	01	01	H3312_049_0	4	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H3312	049	0	1	01	01	H3312_049_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H3312	049	0	1	01	01	H3312_049_0	4	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H3312	049	0	1	01	01	H3312_049_0	4	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3312	049	0	1	01	01	H3312_049_0	4	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3312	049	0	1	01	01	H3312_049_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H3312	050	0	1	01	01	H3312_050_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H3312	050	0	1	01	01	H3312_050_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H3312	050	0	1	01	01	H3312_050_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3312	050	0	1	01	01	H3312_050_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H3312	050	0	1	01	01	H3312_050_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3312	050	0	1	01	01	H3312_050_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3312	050	0	1	01	01	H3312_050_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3312	050	0	1	01	01	H3312_050_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3312	052	0	1	01	01	H3312_052_0	5	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3312	052	0	1	01	01	H3312_052_0	5	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3312	052	0	1	01	01	H3312_052_0	5	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
H3312	052	0	1	01	01	H3312_052_0	5	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
H3327	001	0	1	06	01	H3327_001_0	7	4	1	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles	011011011011001000000	30	90		30	90		30	90		30	90			90								Biological and Specialty Injectibles	2	2		011011011011001000000	Biological and Specialty Injectibles																						Biological and Specialty Injectibles	80.00	160.00		80.00	160.00		80.00	160.00		80.00	160.00			160.00									4
H3327	001	0	1	06	01	H3327_001_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Non-Preferred Brand	2	2		011011011011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00		50.00	100.00		50.00	100.00		50.00	100.00			100.00									4
H3327	001	0	1	06	01	H3327_001_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3327	001	0	1	06	01	H3327_001_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3327	001	0	1	06	01	H3327_001_0	7	4	3	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles																							Biological and Specialty Injectibles					Biological and Specialty Injectibles																						Biological and Specialty Injectibles																						2	4
H3327	001	0	1	06	01	H3327_001_0	7	1	3	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00								1	4
H3327	001	0	1	06	01	H3327_001_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Preferred Brand	2	2		011011011011001000000	Preferred Brand																						Preferred Brand	27.00	54.00		27.00	54.00		27.00	54.00		27.00	54.00			54.00									4
H3327	001	0	1	06	01	H3327_001_0	7	1	1	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00									4
H3327	002	0	1	06	01	H3327_002_0	7	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Non-Preferred Brand	2	2		011011011011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00		50.00	100.00		50.00	100.00		50.00	100.00			100.00									2
H3327	002	0	1	06	01	H3327_002_0	7	2	1	Preferred Brand	000001		2	Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Preferred Brand	2	2		011011011011001000000	Preferred Brand																						Preferred Brand	27.00	54.00		27.00	54.00		27.00	54.00		27.00	54.00			54.00									2
H3327	002	0	1	06	01	H3327_002_0	7	4	1	Biological and Specialty Injectibles	100000		1	Biological and Specialty Injectibles	011011011011001000000	30	90		30	90		30	90		30	90			90								Biological and Specialty Injectibles	2	2		011011011011001000000	Biological and Specialty Injectibles																						Biological and Specialty Injectibles	80.00	160.00		80.00	160.00		80.00	160.00		80.00	160.00			160.00									2
H3327	002	0	1	06	01	H3327_002_0	7	1	1	Generic	010000		2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00									2
H3327	003	0	1	06	01	H3327_003_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3327	003	0	1	06	01	H3327_003_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3327	003	0	1	06	01	H3327_003_0	7	4	3	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles																							Biological and Specialty Injectibles					Biological and Specialty Injectibles																						Biological and Specialty Injectibles																						2	4
H3327	003	0	1	06	01	H3327_003_0	7	1	3	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00								1	4
H3327	003	0	1	06	01	H3327_003_0	7	4	1	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles	011011011011001000000	30	90		30	90		30	90		30	90			90								Biological and Specialty Injectibles	2	2		011011011011001000000	Biological and Specialty Injectibles																						Biological and Specialty Injectibles	80.00	160.00		80.00	160.00		80.00	160.00		80.00	160.00			160.00									4
H3327	003	0	1	06	01	H3327_003_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Non-Preferred Brand	2	2		011011011011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00		50.00	100.00		50.00	100.00		50.00	100.00			100.00									4
H3327	003	0	1	06	01	H3327_003_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Preferred Brand	2	2		011011011011001000000	Preferred Brand																						Preferred Brand	27.00	54.00		27.00	54.00		27.00	54.00		27.00	54.00			54.00									4
H3327	003	0	1	06	01	H3327_003_0	7	1	1	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00									4
H3327	015	0	1	06	01	H3327_015_0	7	2	1	Preferred Brand	000001		2	Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Preferred Brand	2	2		011011011011001000000	Preferred Brand																						Preferred Brand	27.00	54.00		27.00	54.00		27.00	54.00		27.00	54.00			54.00									2
H3327	015	0	1	06	01	H3327_015_0	7	1	1	Generic	010000		2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00									2
H3327	015	0	1	06	01	H3327_015_0	7	4	1	Biological and Specialty Injectibles	100000		1	Biological and Specialty Injectibles	011011011011001000000	30	90		30	90		30	90		30	90			90								Biological and Specialty Injectibles	2	2		011011011011001000000	Biological and Specialty Injectibles																						Biological and Specialty Injectibles	80.00	160.00		80.00	160.00		80.00	160.00		80.00	160.00			160.00									2
H3327	015	0	1	06	01	H3327_015_0	7	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Non-Preferred Brand	2	2		011011011011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00		50.00	100.00		50.00	100.00		50.00	100.00			100.00									2
H3327	021	0	1	06	01	H3327_021_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3327	021	0	1	06	01	H3327_021_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3327	021	0	1	06	01	H3327_021_0	6	4	3	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles																							Biological and Specialty Injectibles					Biological and Specialty Injectibles																						Biological and Specialty Injectibles																						2	4
H3327	021	0	1	06	01	H3327_021_0	6	1	3	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00								1	4
H3327	021	0	1	06	01	H3327_021_0	6	4	1	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles	011011011011001000000	30	90		30	90		30	90		30	90			90								Biological and Specialty Injectibles	2	2		011011011011001000000	Biological and Specialty Injectibles																						Biological and Specialty Injectibles	80.00	160.00		80.00	160.00		80.00	160.00		80.00	160.00			160.00									4
H3327	021	0	1	06	01	H3327_021_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Non-Preferred Brand	2	2		011011011011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00		50.00	100.00		50.00	100.00		50.00	100.00			100.00									4
H3327	021	0	1	06	01	H3327_021_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Preferred Brand	2	2		011011011011001000000	Preferred Brand																						Preferred Brand	27.00	54.00		27.00	54.00		27.00	54.00		27.00	54.00			54.00									4
H3327	021	0	1	06	01	H3327_021_0	6	1	1	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00									4
H3327	023	0	1	06	01	H3327_023_0	6	4	1	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles	011011011011001000000	30	90		30	90		30	90		30	90			90								Biological and Specialty Injectibles	2	2		011011011011001000000	Biological and Specialty Injectibles																						Biological and Specialty Injectibles	80.00	160.00		80.00	160.00		80.00	160.00		80.00	160.00			160.00									4
H3327	023	0	1	06	01	H3327_023_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Non-Preferred Brand	2	2		011011011011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00		50.00	100.00		50.00	100.00		50.00	100.00			100.00									4
H3327	023	0	1	06	01	H3327_023_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3327	023	0	1	06	01	H3327_023_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3327	023	0	1	06	01	H3327_023_0	6	4	3	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles																							Biological and Specialty Injectibles					Biological and Specialty Injectibles																						Biological and Specialty Injectibles																						2	4
H3327	023	0	1	06	01	H3327_023_0	6	1	3	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00								1	4
H3327	023	0	1	06	01	H3327_023_0	6	1	1	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00									4
H3327	023	0	1	06	01	H3327_023_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Preferred Brand	2	2		011011011011001000000	Preferred Brand																						Preferred Brand	27.00	54.00		27.00	54.00		27.00	54.00		27.00	54.00			54.00									4
H3327	024	0	1	06	01	H3327_024_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Non-Preferred Brand	2	2		011011011011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00		50.00	100.00		50.00	100.00		50.00	100.00			100.00									2
H3327	024	0	1	06	01	H3327_024_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Preferred Brand	2	2		011011011011001000000	Preferred Brand																						Preferred Brand	27.00	54.00		27.00	54.00		27.00	54.00		27.00	54.00			54.00									2
H3327	024	0	1	06	01	H3327_024_0	6	4	1	Biological and Specialty Injectibles	100000		1	Biological and Specialty Injectibles	011011011011001000000	30	90		30	90		30	90		30	90			90								Biological and Specialty Injectibles	2	2		011011011011001000000	Biological and Specialty Injectibles																						Biological and Specialty Injectibles	80.00	160.00		80.00	160.00		80.00	160.00		80.00	160.00			160.00									2
H3327	024	0	1	06	01	H3327_024_0	6	1	1	Generic	010000		2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	5.00	10.00		5.00	10.00		5.00	10.00		5.00	10.00			10.00									2
H3327	028	0	1	06	01	H3327_028_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3327	028	0	1	06	01	H3327_028_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3327	028	0	1	06	01	H3327_028_0	7	4	3	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles																							Biological and Specialty Injectibles					Biological and Specialty Injectibles																						Biological and Specialty Injectibles																						2	4
H3327	028	0	1	06	01	H3327_028_0	7	1	3	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	3.00	6.00		3.00	6.00		3.00	6.00		3.00	6.00			6.00								1	4
H3327	028	0	1	06	01	H3327_028_0	7	4	1	Biological and Specialty Injectibles	100000	1	1	Biological and Specialty Injectibles	011011011011001000000	30	90		30	90		30	90		30	90			90								Biological and Specialty Injectibles	2	2		011011011011001000000	Biological and Specialty Injectibles																						Biological and Specialty Injectibles	80.00	160.00		80.00	160.00		80.00	160.00		80.00	160.00			160.00									4
H3327	028	0	1	06	01	H3327_028_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Non-Preferred Brand	2	2		011011011011001000000	Non-Preferred Brand																						Non-Preferred Brand	35.00	70.00		35.00	70.00		35.00	70.00		35.00	70.00			70.00									4
H3327	028	0	1	06	01	H3327_028_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011011011011001000000	30	90		30	90		30	90		30	90			90								Preferred Brand	2	2		011011011011001000000	Preferred Brand																						Preferred Brand	28.00	56.00		28.00	56.00		28.00	56.00		28.00	56.00			56.00									4
H3327	028	0	1	06	01	H3327_028_0	7	1	1	Generic	010000	1	2	Generic	011011011011001000000	30	90		30	90		30	90		30	90			90								Generic	2	2		011011011011001000000	Generic																						Generic	3.00	6.00		3.00	6.00		3.00	6.00		3.00	6.00			6.00									4
H3328	003	0	1	02	01	H3328_003_0	4	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	12.00	36.00								12.00				35.00									3
H3328	003	0	1	02	01	H3328_003_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				55.00									3
H3328	003	0	1	02	01	H3328_003_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	55.00	165.00								55.00				55.00									3
H3328	003	0	1	02	01	H3328_003_0	4	4	1	Specialty	000001		1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H3328	008	0	1	02	01	H3328_008_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				55.00									3
H3328	008	0	1	02	01	H3328_008_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	55.00	165.00								55.00				55.00									3
H3328	008	0	1	02	01	H3328_008_0	4	4	1	Specialty	000001		1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H3328	008	0	1	02	01	H3328_008_0	4	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	12.00	36.00								12.00				35.00									3
H3328	011	0	1	02	01	H3328_011_0	4	4	1	Specialty	000001		1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H3328	011	0	1	02	01	H3328_011_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	55.00	165.00								55.00				55.00									3
H3328	011	0	1	02	01	H3328_011_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				55.00									3
H3328	011	0	1	02	01	H3328_011_0	4	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	12.00	36.00								12.00				35.00									3
H3330	021	1	1	01	01	H3330_021_1	9	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
H3330	021	1	1	01	01	H3330_021_1	9	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3330	021	1	1	01	01	H3330_021_1	9	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3330	021	1	1	01	01	H3330_021_1	9	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3330	021	1	1	01	01	H3330_021_1	9	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
H3330	021	1	1	01	01	H3330_021_1	9	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
H3330	021	1	1	01	01	H3330_021_1	9	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
H3330	021	1	1	01	01	H3330_021_1	9	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
H3330	021	2	1	01	01	H3330_021_2	9	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
H3330	021	2	1	01	01	H3330_021_2	9	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
H3330	021	2	1	01	01	H3330_021_2	9	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
H3330	021	2	1	01	01	H3330_021_2	9	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
H3330	021	2	1	01	01	H3330_021_2	9	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3330	021	2	1	01	01	H3330_021_2	9	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3330	021	2	1	01	01	H3330_021_2	9	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
H3330	021	2	1	01	01	H3330_021_2	9	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3330	021	3	1	01	01	H3330_021_3	9	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
H3330	021	3	1	01	01	H3330_021_3	9	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
H3330	021	3	1	01	01	H3330_021_3	9	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
H3330	021	3	1	01	01	H3330_021_3	9	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
H3330	021	3	1	01	01	H3330_021_3	9	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3330	021	3	1	01	01	H3330_021_3	9	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3330	021	3	1	01	01	H3330_021_3	9	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
H3330	021	3	1	01	01	H3330_021_3	9	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3330	023	1	1	01	01	H3330_023_1	11	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
H3330	023	1	1	01	01	H3330_023_1	11	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3330	023	1	1	01	01	H3330_023_1	11	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
H3330	023	1	1	01	01	H3330_023_1	11	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
H3330	023	1	1	01	01	H3330_023_1	11	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
H3330	023	1	1	01	01	H3330_023_1	11	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
H3330	023	1	1	01	01	H3330_023_1	11	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3330	023	1	1	01	01	H3330_023_1	11	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3330	023	2	1	01	01	H3330_023_2	11	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3330	023	2	1	01	01	H3330_023_2	11	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
H3330	023	2	1	01	01	H3330_023_2	11	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
H3330	023	2	1	01	01	H3330_023_2	11	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
H3330	023	2	1	01	01	H3330_023_2	11	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
H3330	023	2	1	01	01	H3330_023_2	11	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
H3330	023	2	1	01	01	H3330_023_2	11	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3330	023	2	1	01	01	H3330_023_2	11	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3330	023	3	1	01	01	H3330_023_3	11	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
H3330	023	3	1	01	01	H3330_023_3	11	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
H3330	023	3	1	01	01	H3330_023_3	11	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3330	023	3	1	01	01	H3330_023_3	11	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3330	023	3	1	01	01	H3330_023_3	11	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3330	023	3	1	01	01	H3330_023_3	11	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
H3330	023	3	1	01	01	H3330_023_3	11	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
H3330	023	3	1	01	01	H3330_023_3	11	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
H3330	026	0	2	01	01	H3330_026_0	9	1	1	Tier 1	001000		2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				5.00	7.50	10.00	5.00	15.00	10.00	5.00			2.50	7.50	5.00								2
H3330	026	0	2	01	01	H3330_026_0	9	4	1	Tier 4	010010		1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							2
H3330	026	0	2	01	01	H3330_026_0	9	3	1	Tier 3	100100		2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				40	40	40	40	40	40	40			40	40	40							Tier 3																							2
H3330	026	0	2	01	01	H3330_026_0	9	2	1	Tier 2	000001		2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	1	000011111110011100000		Tier 2				25	25	25	25	25	25	25			25	25	25							Tier 2																							2
H3330	029	0	1	01	01	H3330_029_0	12	2	1	Tier 2	000001		2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	1	000011111110011100000		Tier 2				25	25	25	25	25	25	25			25	25	25							Tier 2																							2
H3330	029	0	1	01	01	H3330_029_0	12	3	1	Tier 3	100100		2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				40	40	40	40	40	40	40			40	40	40							Tier 3																							2
H3330	029	0	1	01	01	H3330_029_0	12	1	1	Tier 1	001000		2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				5.00	7.50	10.00	5.00	15.00	10.00	5.00			2.50	7.50	5.00								2
H3330	029	0	1	01	01	H3330_029_0	12	4	1	Tier 4	010010		1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							2
H3330	030	1	1	01	01	H3330_030_1	10	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3330	030	1	1	01	01	H3330_030_1	10	5	3	Tier 5	001001	1	2	Tier 5	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 5	2	2		000011111110011100000	Tier 5																						Tier 5				0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00	0.00							1	4
H3330	030	1	1	01	01	H3330_030_1	10	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
H3330	030	1	1	01	01	H3330_030_1	10	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
H3330	030	1	1	01	01	H3330_030_1	10	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
H3330	030	1	1	01	01	H3330_030_1	10	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
H3330	030	1	1	01	01	H3330_030_1	10	5	1	Tier 5	001001	1	2	Tier 5	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 5	2	2		000011111110011100000	Tier 5																						Tier 5				0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00	0.00								4
H3330	030	1	1	01	01	H3330_030_1	10	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
H3330	030	1	1	01	01	H3330_030_1	10	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3330	030	1	1	01	01	H3330_030_1	10	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3330	030	2	1	01	01	H3330_030_2	10	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
H3330	030	2	1	01	01	H3330_030_2	10	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
H3330	030	2	1	01	01	H3330_030_2	10	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
H3330	030	2	1	01	01	H3330_030_2	10	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
H3330	030	2	1	01	01	H3330_030_2	10	5	3	Tier 5	001001	1	2	Tier 5	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 5	2	2		000011111110011100000	Tier 5																						Tier 5				0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00	0.00							1	4
H3330	030	2	1	01	01	H3330_030_2	10	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
H3330	030	2	1	01	01	H3330_030_2	10	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3330	030	2	1	01	01	H3330_030_2	10	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3330	030	2	1	01	01	H3330_030_2	10	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3330	030	2	1	01	01	H3330_030_2	10	5	1	Tier 5	001001	1	2	Tier 5	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 5	2	2		000011111110011100000	Tier 5																						Tier 5				0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00	0.00								4
H3330	030	3	1	01	01	H3330_030_3	12	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
H3330	030	3	1	01	01	H3330_030_3	12	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
H3330	030	3	1	01	01	H3330_030_3	12	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
H3330	030	3	1	01	01	H3330_030_3	12	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
H3330	030	3	1	01	01	H3330_030_3	12	5	3	Tier 5	001001	1	2	Tier 5	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 5	2	2		000011111110011100000	Tier 5																						Tier 5				0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00	0.00							1	4
H3330	030	3	1	01	01	H3330_030_3	12	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3330	030	3	1	01	01	H3330_030_3	12	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3330	030	3	1	01	01	H3330_030_3	12	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3330	030	3	1	01	01	H3330_030_3	12	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
H3330	030	3	1	01	01	H3330_030_3	12	5	1	Tier 5	001001	1	2	Tier 5	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 5	2	2		000011111110011100000	Tier 5																						Tier 5				0.00	0.00	0.00	0.00	0.00	0.00	0.00			0.00	0.00	0.00								4
H3333	025	0	1	09	04	H3333_025_0	7	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									3
H3333	025	0	1	09	04	H3333_025_0	7	4	1	Tier 4	100000		1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							3
H3333	025	0	1	09	04	H3333_025_0	7	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	63.00	126.00								63.00	126.00			126.00									3
H3333	025	0	1	09	04	H3333_025_0	7	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									3
H3333	026	0	1	09	04	H3333_026_0	7	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	63.00	126.00								63.00	126.00			126.00									3
H3333	026	0	1	09	04	H3333_026_0	7	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									3
H3333	026	0	1	09	04	H3333_026_0	7	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									3
H3333	026	0	1	09	04	H3333_026_0	7	4	1	Tier 4	100000		1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							3
H3333	027	0	1	09	04	H3333_027_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									4
H3333	027	0	1	09	04	H3333_027_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									4
H3333	027	0	1	09	04	H3333_027_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	63.00	126.00								63.00	126.00			126.00									4
H3333	027	0	1	09	04	H3333_027_0	6	4	1	Tier 4	100000	1	1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
H3333	027	0	1	09	04	H3333_027_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00								1	4
H3333	027	0	1	09	04	H3333_027_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3333	027	0	1	09	04	H3333_027_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3333	027	0	1	09	04	H3333_027_0	6	4	3	Tier 4	100000	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3333	028	0	1	09	04	H3333_028_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									4
H3333	028	0	1	09	04	H3333_028_0	7	4	3	Tier 4	100000	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3333	028	0	1	09	04	H3333_028_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									4
H3333	028	0	1	09	04	H3333_028_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3333	028	0	1	09	04	H3333_028_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3333	028	0	1	09	04	H3333_028_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00								1	4
H3333	028	0	1	09	04	H3333_028_0	7	4	1	Tier 4	100000	1	1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
H3333	028	0	1	09	04	H3333_028_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	63.00	126.00								63.00	126.00			126.00									4
H3335	002	0	1	04	01	H3335_002_0	3	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H3335	002	0	1	04	01	H3335_002_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	002	0	1	04	01	H3335_002_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	30	25								30				25								Brand																							4
H3335	002	0	1	04	01	H3335_002_0	3	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50								1	4
H3335	005	0	1	04	01	H3335_005_0	3	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50								1	4
H3335	005	0	1	04	01	H3335_005_0	3	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H3335	005	0	1	04	01	H3335_005_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	005	0	1	04	01	H3335_005_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	25	20								25				20								Brand																							4
H3335	006	0	1	04	01	H3335_006_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	30	25								30				25								Brand																							4
H3335	006	0	1	04	01	H3335_006_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	008	0	1	04	01	H3335_008_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	25	20								25				20								Brand																							4
H3335	008	0	1	04	01	H3335_008_0	3	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50								1	4
H3335	008	0	1	04	01	H3335_008_0	3	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H3335	008	0	1	04	01	H3335_008_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	009	0	1	04	01	H3335_009_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	009	0	1	04	01	H3335_009_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	30	25								30				25								Brand																							4
H3335	014	0	1	04	01	H3335_014_0	3	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H3335	014	0	1	04	01	H3335_014_0	3	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50								1	4
H3335	014	0	1	04	01	H3335_014_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	014	0	1	04	01	H3335_014_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	25	20								25				20								Brand																							4
H3335	015	0	1	04	01	H3335_015_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	015	0	1	04	01	H3335_015_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	30	25								30				25								Brand																							4
H3335	017	0	1	04	01	H3335_017_0	4	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H3335	017	0	1	04	01	H3335_017_0	4	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50								1	4
H3335	017	0	1	04	01	H3335_017_0	4	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	017	0	1	04	01	H3335_017_0	4	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	25	20								25				20								Brand																							4
H3335	018	0	1	04	01	H3335_018_0	4	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	30	25								30				25								Brand																							4
H3335	018	0	1	04	01	H3335_018_0	4	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	020	0	1	04	01	H3335_020_0	3	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50								1	4
H3335	020	0	1	04	01	H3335_020_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	25	20								25				20								Brand																							4
H3335	020	0	1	04	01	H3335_020_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	020	0	1	04	01	H3335_020_0	3	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H3335	021	0	1	04	01	H3335_021_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3335	021	0	1	04	01	H3335_021_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	30	25								30				25								Brand																							4
H3335	032	0	1	04	01	H3335_032_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	30	25								30				25								Brand																							4
H3335	032	0	1	04	01	H3335_032_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									4
H3337	001	0	1	01	01	H3337_001_0	3	3	1	Liberty Choice Drugs	000010	3	2	Liberty Choice Drugs	010000000010000000000	31									31												Liberty Choice Drugs	2	2		010000000010000000000	Liberty Choice Drugs																						Liberty Choice Drugs	10.00									10.00													4
H3337	001	0	1	01	01	H3337_001_0	3	4	1	Preferred Brands	000001	1	2	Preferred Brands	010000000010000000000	31									31												Preferred Brands	2	2		010000000010000000000	Preferred Brands																						Preferred Brands	25.00									25.00													4
H3337	001	0	1	01	01	H3337_001_0	3	5	1	Brands	000010	1	2	Brands	010000000010000000000	31									31												Brands	2	2		010000000010000000000	Brands																						Brands	50.00									50.00													4
H3337	001	0	1	01	01	H3337_001_0	3	6	1	Specialty Drugs	100000	1	1	Specialty Drugs	010000000010000000000	31									31												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H3337	001	0	1	01	01	H3337_001_0	3	1	1	Preferred Generics	001000	3	2	Preferred Generics	011100000011111100000	31	92	62							31	92	62	31	92	62							Preferred Generics	2	2		011100000011111100000	Preferred Generics																						Preferred Generics	0.00	0.00	0.00							0.00	0.00	0.00	0.00	0.00	0.00								4
H3337	001	0	1	01	01	H3337_001_0	3	2	1	Generics	010000	3	2	Generics	011100000011111100000	31	92	62							31	92	62	31	92	62							Generics	2	2		011100000011111100000	Generics																						Generics	10.00	30.00	20.00							10.00	30.00	20.00	10.00	30.00	20.00								4
H3337	001	0	1	01	01	H3337_001_0	3	1	3	Preferred Generics	001000	3	2	Preferred Generics	011100000011111100000	31	92	62							31	92	62	31	92	62							Preferred Generics	2	2		011100000011111100000	Preferred Generics																						Preferred Generics	0.00	0.00	0.00							0.00	0.00	0.00	0.00	0.00	0.00							1	4
H3337	001	0	1	01	01	H3337_001_0	3	2	3	Generics	010000	3	2	Generics	011100000011111100000	31	92	62							31	92	62	31	92	62							Generics	2	2		011100000011111100000	Generics																						Generics	10.00	30.00	20.00							10.00	30.00	20.00	10.00	30.00	20.00							1	4
H3337	001	0	1	01	01	H3337_001_0	3	3	3	Liberty Choice Drugs	000010	3	2	Liberty Choice Drugs																							Liberty Choice Drugs					Liberty Choice Drugs																						Liberty Choice Drugs																						2	4
H3337	001	0	1	01	01	H3337_001_0	3	4	3	Preferred Brands	000001	1	2	Preferred Brands																							Preferred Brands					Preferred Brands																						Preferred Brands																						2	4
H3337	001	0	1	01	01	H3337_001_0	3	5	3	Brands	000010	1	2	Brands																							Brands					Brands																						Brands																						2	4
H3337	001	0	1	01	01	H3337_001_0	3	6	3	Specialty Drugs	100000	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3337	004	0	1	01	01	H3337_004_0	4	2	3	Generics	010000	3	2	Generics	011100000011111100000	31	92	62							31	92	62	31	92	62							Generics	2	2		011100000011111100000	Generics																						Generics	10.00	30.00	20.00							10.00	30.00	20.00	10.00	30.00	20.00							1	4
H3337	004	0	1	01	01	H3337_004_0	4	3	3	Liberty Choice Drugs	000010	3	2	Liberty Choice Drugs																							Liberty Choice Drugs					Liberty Choice Drugs																						Liberty Choice Drugs																						2	4
H3337	004	0	1	01	01	H3337_004_0	4	4	3	Preferred Brands	000001	1	2	Preferred Brands																							Preferred Brands					Preferred Brands																						Preferred Brands																						2	4
H3337	004	0	1	01	01	H3337_004_0	4	5	3	Brands	000010	1	2	Brands																							Brands					Brands																						Brands																						2	4
H3337	004	0	1	01	01	H3337_004_0	4	6	3	Specialty Drugs	100000	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3337	004	0	1	01	01	H3337_004_0	4	1	1	Preferred Generics	001000	3	2	Preferred Generics	011100000011111100000	31	92	62							31	92	62	31	92	62							Preferred Generics	2	2		011100000011111100000	Preferred Generics																						Preferred Generics	0.00	0.00	0.00							0.00	0.00	0.00	0.00	0.00	0.00								4
H3337	004	0	1	01	01	H3337_004_0	4	2	1	Generics	010000	3	2	Generics	011100000011111100000	31	92	62							31	92	62	31	92	62							Generics	2	2		011100000011111100000	Generics																						Generics	10.00	30.00	20.00							10.00	30.00	20.00	10.00	30.00	20.00								4
H3337	004	0	1	01	01	H3337_004_0	4	3	1	Liberty Choice Drugs	000010	3	2	Liberty Choice Drugs	010000000010000000000	31									31												Liberty Choice Drugs	2	2		010000000010000000000	Liberty Choice Drugs																						Liberty Choice Drugs	10.00									10.00													4
H3337	004	0	1	01	01	H3337_004_0	4	4	1	Preferred Brands	000001	1	2	Preferred Brands	010000000010000000000	31									31												Preferred Brands	2	2		010000000010000000000	Preferred Brands																						Preferred Brands	25.00									25.00													4
H3337	004	0	1	01	01	H3337_004_0	4	5	1	Brands	000010	1	2	Brands	010000000010000000000	31									31												Brands	2	2		010000000010000000000	Brands																						Brands	50.00									50.00													4
H3337	004	0	1	01	01	H3337_004_0	4	6	1	Specialty Drugs	100000	1	1	Specialty Drugs	010000000010000000000	31									31												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H3337	004	0	1	01	01	H3337_004_0	4	1	3	Preferred Generics	001000	3	2	Preferred Generics	011100000011111100000	31	92	62							31	92	62	31	92	62							Preferred Generics	2	2		011100000011111100000	Preferred Generics																						Preferred Generics	0.00	0.00	0.00							0.00	0.00	0.00	0.00	0.00	0.00							1	4
H3342	001	0	1	04	01	H3342_001_0	5	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									4
H3342	001	0	1	04	01	H3342_001_0	5	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3342	001	0	1	04	01	H3342_001_0	5	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3342	001	0	1	04	01	H3342_001_0	5	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3342	002	0	1	04	01	H3342_002_0	4	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3342	002	0	1	04	01	H3342_002_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3342	002	0	1	04	01	H3342_002_0	4	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3342	002	0	1	04	01	H3342_002_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									4
H3342	003	0	1	04	01	H3342_003_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									4
H3342	003	0	1	04	01	H3342_003_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3342	003	0	1	04	01	H3342_003_0	4	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3342	003	0	1	04	01	H3342_003_0	4	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3342	004	0	1	04	01	H3342_004_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3342	004	0	1	04	01	H3342_004_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									4
H3342	004	0	1	04	01	H3342_004_0	4	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3342	004	0	1	04	01	H3342_004_0	4	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3344	003	0	1	04	01	H3344_003_0	8	2	1	Formulary Preferred Brand	000011	1	2	Formulary Preferred Brand	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		Formulary Preferred Brand	2	2		011011011011001001001	Formulary Preferred Brand																						Formulary Preferred Brand	20.00	60.00		20.00	60.00		20.00	60.00		20.00	60.00			60.00			60.00			60.00			4
H3344	003	0	1	04	01	H3344_003_0	8	5	3	OTC	000010	1	2	OTC	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		OTC	2	2		011011011011001001001	OTC																						OTC	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			0.00			0.00			0.00		1	4
H3344	003	0	1	04	01	H3344_003_0	8	4	3	Specialty Drugs	111111	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3344	003	0	1	04	01	H3344_003_0	8	3	3	Formulary Brand	100011	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H3344	003	0	1	04	01	H3344_003_0	8	2	3	Formulary Preferred Brand	000011	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H3344	003	0	1	04	01	H3344_003_0	8	1	3	Formulary Generic	011100	1	2	Formulary Generic	011011011011001001001	30	90		30	90		30	90		30	90			30			90			90		Formulary Generic	2	2		011011011011001001001	Formulary Generic																						Formulary Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00			15.00			15.00			15.00		1	4
H3344	003	0	1	04	01	H3344_003_0	8	5	1	OTC	000010	1	2	OTC	010010010010000000000	30			30			30			30												OTC	2	2		010010010010000000000	OTC																						OTC	0.00			0.00			0.00			0.00													4
H3344	003	0	1	04	01	H3344_003_0	8	1	1	Formulary Generic	011100	1	2	Formulary Generic	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		Formulary Generic	2	2		011011011011001001001	Formulary Generic																						Formulary Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00			15.00			15.00			15.00			4
H3344	003	0	1	04	01	H3344_003_0	8	3	1	Formulary Brand	100011	1	2	Formulary Brand	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		Formulary Brand	2	2		011011011011001001001	Formulary Brand																						Formulary Brand	35.00	105.00		35.00	105.00		35.00	105.00		35.00	105.00			105.00			105.00			105.00			4
H3344	003	0	1	04	01	H3344_003_0	8	4	1	Specialty Drugs	111111	1	1	Specialty Drugs	000010000010000000000				30						30												Specialty Drugs	2	1	000010000010000000000		Specialty Drugs				25						25												Specialty Drugs																							4
H3345	001	1	1	04	01	H3345_001_1	11	1	1	Tier 1	001000		2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				5.00	7.50	10.00	5.00	15.00	10.00	5.00			2.50	7.50	5.00								2
H3345	001	1	1	04	01	H3345_001_1	11	3	1	Tier 3	100100		2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				40	40	40	40	40	40	40			40	40	40							Tier 3																							2
H3345	001	1	1	04	01	H3345_001_1	11	4	1	Tier 4	010010		1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							2
H3345	001	1	1	04	01	H3345_001_1	11	2	1	Tier 2	000001		2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	1	000011111110011100000		Tier 2				25	25	25	25	25	25	25			25	25	25							Tier 2																							2
H3345	001	2	1	04	01	H3345_001_2	11	2	1	Tier 2	000001		2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	1	000011111110011100000		Tier 2				25	25	25	25	25	25	25			25	25	25							Tier 2																							2
H3345	001	2	1	04	01	H3345_001_2	11	3	1	Tier 3	100100		2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				40	40	40	40	40	40	40			40	40	40							Tier 3																							2
H3345	001	2	1	04	01	H3345_001_2	11	4	1	Tier 4	010010		1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							2
H3345	001	2	1	04	01	H3345_001_2	11	1	1	Tier 1	001000		2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				5.00	7.50	10.00	5.00	15.00	10.00	5.00			2.50	7.50	5.00								2
H3345	001	3	1	04	01	H3345_001_3	11	3	1	Tier 3	100100		2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				40	40	40	40	40	40	40			40	40	40							Tier 3																							2
H3345	001	3	1	04	01	H3345_001_3	11	4	1	Tier 4	010010		1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							2
H3345	001	3	1	04	01	H3345_001_3	11	2	1	Tier 2	000001		2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	1	000011111110011100000		Tier 2				25	25	25	25	25	25	25			25	25	25							Tier 2																							2
H3345	001	3	1	04	01	H3345_001_3	11	1	1	Tier 1	001000		2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				5.00	7.50	10.00	5.00	15.00	10.00	5.00			2.50	7.50	5.00								2
H3346	002	0	1	04	01	H3346_002_0	6	3	3	Tier 3	000010	1	1	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3346	002	0	1	04	01	H3346_002_0	6	2	3	Tier 2	000010	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3346	002	0	1	04	01	H3346_002_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000011011000000	34	90								34	90		34	90								Tier 1	1	2		011000000011011000000	Tier 1																						Tier 1	8.00	24.00								8.00	24.00		16.00	16.00								1	4
H3346	002	0	1	04	01	H3346_002_0	6	3	1	Tier 3	000010	1	1	Tier 3	011000000011011000000	34	90								34	90		34	90								Tier 3	1	1	011000000011011000000		Tier 3	25	25								25	25		25	25								Tier 3																							4
H3346	002	0	1	04	01	H3346_002_0	6	2	1	Tier 2	000010	1	2	Tier 2	011000000011011000000	34	90								34	90		34	90								Tier 2	1	2		011000000011011000000	Tier 2																						Tier 2	40.00	120.00								40.00	120.00		80.00	80.00									4
H3346	002	0	1	04	01	H3346_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011011000000	34	90								34	90		34	90								Tier 1	1	2		011000000011011000000	Tier 1																						Tier 1	8.00	24.00								8.00	24.00		16.00	16.00									4
H3347	001	0	1	01	01	H3347_001_0	5	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									4
H3347	001	0	1	01	01	H3347_001_0	5	2	1	Preferred	000001	1	2	Preferred	011000000011001000000	30	90								30	90			90								Preferred	2	2		011000000011001000000	Preferred																						Preferred	25.00	75.00								25.00	75.00			62.50									4
H3347	001	0	1	01	01	H3347_001_0	5	3	1	Brand	100010	1	2	Brand	011000000011001000000	30	90								30	90			90								Brand	2	2		011000000011001000000	Brand																						Brand	60.00	180.00								60.00	180.00			150.00									4
H3347	001	0	1	01	01	H3347_001_0	5	4	1	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	3	011000000011001000000	011000000011001000000	Specialty	25	25								25	25			25								Specialty	60.00	180.00								60.00	180.00			150.00									4
H3351	002	0	1	01	01	H3351_002_0	4	2	1	Formulary Brand	000010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	35.00	87.50								35.00				87.50									4
H3351	002	0	1	01	01	H3351_002_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00				12.50									4
H3351	002	0	1	01	01	H3351_002_0	4	3	1	Specialty	000010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	28								33				28								Specialty																							4
H3351	006	0	1	01	01	H3351_006_0	5	2	1	Formulary Brand	000010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	38.00	95.00								38.00				95.00									4
H3351	006	0	1	01	01	H3351_006_0	5	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00				12.50									4
H3351	006	0	1	01	01	H3351_006_0	5	3	1	Specialty	000010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	28								33				28								Specialty																							4
H3356	001	0	1	18	06	H3356_001_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00				12.50									4
H3356	001	0	1	18	06	H3356_001_0	4	2	1	Formulary Brand	000010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	37.00	92.50								37.00				92.50									4
H3356	001	0	1	18	06	H3356_001_0	4	3	1	Specialty	000010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	28								33				28								Specialty																							4
H3359	001	0	1	01	01	H3359_001_0	8	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	1	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H3359	001	0	1	01	01	H3359_001_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				105.00									4
H3359	001	0	1	01	01	H3359_001_0	8	3	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	1	2		011000000010001000000	Specialty																						Specialty	85.00	255.00								85.00				170.00									4
H3361	019	0	1	01	01	H3361_019_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	019	0	1	01	01	H3361_019_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H3361	019	0	1	01	01	H3361_019_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H3361	019	0	1	01	01	H3361_019_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	019	0	1	01	01	H3361_019_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H3361	019	0	1	01	01	H3361_019_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3361	019	0	1	01	01	H3361_019_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3361	019	0	1	01	01	H3361_019_0	4	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3361	020	0	1	01	01	H3361_020_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	95.00	285.00								95.00	285.00			285.00									4
H3361	020	0	1	01	01	H3361_020_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H3361	020	0	1	01	01	H3361_020_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	020	0	1	01	01	H3361_020_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	020	0	1	01	01	H3361_020_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3361	020	0	1	01	01	H3361_020_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3361	020	0	1	01	01	H3361_020_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3361	020	0	1	01	01	H3361_020_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H3361	021	0	1	01	01	H3361_021_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	021	0	1	01	01	H3361_021_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H3361	021	0	1	01	01	H3361_021_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									4
H3361	021	0	1	01	01	H3361_021_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3361	021	0	1	01	01	H3361_021_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3361	021	0	1	01	01	H3361_021_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H3361	021	0	1	01	01	H3361_021_0	6	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	021	0	1	01	01	H3361_021_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3361	022	0	1	01	01	H3361_022_0	9	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H3361	022	0	1	01	01	H3361_022_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H3361	022	0	1	01	01	H3361_022_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	022	0	1	01	01	H3361_022_0	9	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	022	0	1	01	01	H3361_022_0	9	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3361	022	0	1	01	01	H3361_022_0	9	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3361	022	0	1	01	01	H3361_022_0	9	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3361	022	0	1	01	01	H3361_022_0	9	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H3361	024	0	1	01	01	H3361_024_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	95.00	285.00								95.00	285.00			285.00									4
H3361	024	0	1	01	01	H3361_024_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H3361	024	0	1	01	01	H3361_024_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	024	0	1	01	01	H3361_024_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	024	0	1	01	01	H3361_024_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H3361	024	0	1	01	01	H3361_024_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3361	024	0	1	01	01	H3361_024_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3361	024	0	1	01	01	H3361_024_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3361	027	0	1	01	01	H3361_027_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	95.00	285.00								95.00	285.00			285.00									4
H3361	027	0	1	01	01	H3361_027_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H3361	027	0	1	01	01	H3361_027_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	027	0	1	01	01	H3361_027_0	6	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	051	0	1	01	01	H3361_051_0	9	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	90.00	270.00								90.00	270.00			270.00									4
H3361	051	0	1	01	01	H3361_051_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H3361	051	0	1	01	01	H3361_051_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	051	0	1	01	01	H3361_051_0	9	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	062	0	1	01	01	H3361_062_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3361	062	0	1	01	01	H3361_062_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H3361	062	0	1	01	01	H3361_062_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	062	0	1	01	01	H3361_062_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3361	062	0	1	01	01	H3361_062_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H3361	062	0	1	01	01	H3361_062_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3361	062	0	1	01	01	H3361_062_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	062	0	1	01	01	H3361_062_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H3361	086	0	1	01	01	H3361_086_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	086	0	1	01	01	H3361_086_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H3361	086	0	1	01	01	H3361_086_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	95.00	285.00								95.00	285.00			285.00									4
H3361	086	0	1	01	01	H3361_086_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	086	0	1	01	01	H3361_086_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H3361	086	0	1	01	01	H3361_086_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3361	086	0	1	01	01	H3361_086_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3361	086	0	1	01	01	H3361_086_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3361	099	0	1	01	01	H3361_099_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	099	0	1	01	01	H3361_099_0	8	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	099	0	1	01	01	H3361_099_0	8	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H3361	099	0	1	01	01	H3361_099_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H3361	100	0	1	01	01	H3361_100_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	100	0	1	01	01	H3361_100_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H3361	100	0	1	01	01	H3361_100_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H3361	100	0	1	01	01	H3361_100_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	102	0	1	01	01	H3361_102_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	102	0	1	01	01	H3361_102_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H3361	102	0	1	01	01	H3361_102_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	102	0	1	01	01	H3361_102_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H3361	104	0	1	01	01	H3361_104_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	104	0	1	01	01	H3361_104_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	75.00	225.00								75.00	225.00			225.00									4
H3361	104	0	1	01	01	H3361_104_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	45.00	135.00								45.00	135.00			135.00									4
H3361	104	0	1	01	01	H3361_104_0	4	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	106	0	1	01	01	H3361_106_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H3361	106	0	1	01	01	H3361_106_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3361	106	0	1	01	01	H3361_106_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3361	106	0	1	01	01	H3361_106_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3361	106	0	1	01	01	H3361_106_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3361	106	0	1	01	01	H3361_106_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H3361	106	0	1	01	01	H3361_106_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	95.00	285.00								95.00	285.00			285.00									4
H3361	106	0	1	01	01	H3361_106_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	107	0	1	01	01	H3361_107_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H3361	107	0	1	01	01	H3361_107_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H3361	107	0	1	01	01	H3361_107_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H3361	107	0	1	01	01	H3361_107_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H3361	107	0	1	01	01	H3361_107_0	5	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H3361	107	0	1	01	01	H3361_107_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	95.00	285.00								95.00	285.00			285.00									4
H3361	107	0	1	01	01	H3361_107_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	35.00	105.00								35.00	105.00			105.00									4
H3361	107	0	1	01	01	H3361_107_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H3362	004	0	1	01	01	H3362_004_0	9	1	3	Formulary Generic	011100	1	2	Formulary Generic	011011011011001001001	30	90		30	90		30	90		30	90			30			90			90		Formulary Generic	2	2		011011011011001001001	Formulary Generic																						Formulary Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00			15.00			15.00			15.00		1	4
H3362	004	0	1	01	01	H3362_004_0	9	5	1	OTC	000010	1	2	OTC	010010010010000000000	30			30			30			30												OTC	2	2		010010010010000000000	OTC																						OTC	0.00			0.00			0.00			0.00													4
H3362	004	0	1	01	01	H3362_004_0	9	4	1	Specialty Drugs	111111	1	1	Specialty Drugs	000010000010000000000				30						30												Specialty Drugs	2	1	000010000010000000000		Specialty Drugs				25						25												Specialty Drugs																							4
H3362	004	0	1	01	01	H3362_004_0	9	3	1	Formulary Brand	100011	1	2	Formulary Brand	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		Formulary Brand	2	2		011011011011001001001	Formulary Brand																						Formulary Brand	40.00	120.00		40.00	120.00		40.00	120.00		40.00	120.00			120.00			120.00			120.00			4
H3362	004	0	1	01	01	H3362_004_0	9	2	1	Formulary Preferred Brand	000011	1	2	Formulary Preferred Brand	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		Formulary Preferred Brand	2	2		011011011011001001001	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00			75.00			75.00			75.00			4
H3362	004	0	1	01	01	H3362_004_0	9	1	1	Formulary Generic	011100	1	2	Formulary Generic	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		Formulary Generic	2	2		011011011011001001001	Formulary Generic																						Formulary Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00			15.00			15.00			15.00			4
H3362	004	0	1	01	01	H3362_004_0	9	5	3	OTC	000010	1	2	OTC	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		OTC	2	2		011011011011001001001	OTC																						OTC	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			0.00			0.00			0.00		1	4
H3362	004	0	1	01	01	H3362_004_0	9	4	3	Specialty Drugs	111111	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3362	004	0	1	01	01	H3362_004_0	9	2	3	Formulary Preferred Brand	000011	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H3362	004	0	1	01	01	H3362_004_0	9	3	3	Formulary Brand	100011	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H3366	008	0	1	01	01	H3366_008_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H3366	008	0	1	01	01	H3366_008_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	33.00	99.00	66.00							33.00	99.00	66.00		66.00	66.00								4
H3366	008	0	1	01	01	H3366_008_0	3	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H3366	008	0	1	01	01	H3366_008_0	3	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
H3366	008	0	1	01	01	H3366_008_0	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H3366	008	0	1	01	01	H3366_008_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3366	008	0	1	01	01	H3366_008_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	66.00	198.00	132.00							66.00	198.00	132.00		165.00	132.00								4
H3366	008	0	1	01	01	H3366_008_0	3	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H3366	008	0	1	01	01	H3366_008_0	3	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H3366	008	0	1	01	01	H3366_008_0	3	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00							1	4
H3366	022	0	1	01	01	H3366_022_0	4	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
H3366	022	0	1	01	01	H3366_022_0	4	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	50.00	150.00	100.00							50.00	150.00	100.00		125.00	100.00								3
H3366	022	0	1	01	01	H3366_022_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	26.00	78.00	52.00							26.00	78.00	52.00		52.00	52.00								3
H3366	022	0	1	01	01	H3366_022_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
H3366	022	0	1	01	01	H3366_022_0	4	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
H3370	001	0	1	01	01	H3370_001_0	4	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	24.00								8.00				16.00								1	4
H3370	001	0	1	01	01	H3370_001_0	4	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3370	001	0	1	01	01	H3370_001_0	4	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3370	001	0	1	01	01	H3370_001_0	4	4	3	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand																							Specialty Formulary Brand					Specialty Formulary Brand																						Specialty Formulary Brand																						2	4
H3370	001	0	1	01	01	H3370_001_0	4	3	3	Formulary Brand	100010	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H3370	001	0	1	01	01	H3370_001_0	4	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H3370	001	0	1	01	01	H3370_001_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	24.00								8.00				16.00									4
H3370	001	0	1	01	01	H3370_001_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3370	002	0	1	01	01	H3370_002_0	6	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									4
H3370	002	0	1	01	01	H3370_002_0	6	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3370	002	0	1	01	01	H3370_002_0	6	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3370	002	0	1	01	01	H3370_002_0	6	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3370	003	0	1	01	01	H3370_003_0	4	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00								1	4
H3370	003	0	1	01	01	H3370_003_0	4	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3370	003	0	1	01	01	H3370_003_0	4	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3370	003	0	1	01	01	H3370_003_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3370	003	0	1	01	01	H3370_003_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									4
H3370	003	0	1	01	01	H3370_003_0	4	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H3370	003	0	1	01	01	H3370_003_0	4	4	3	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand																							Specialty Formulary Brand					Specialty Formulary Brand																						Specialty Formulary Brand																						2	4
H3370	003	0	1	01	01	H3370_003_0	4	3	3	Formulary Brand	100010	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H3370	004	0	1	01	01	H3370_004_0	6	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3370	004	0	1	01	01	H3370_004_0	6	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3370	004	0	1	01	01	H3370_004_0	6	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									4
H3370	004	0	1	01	01	H3370_004_0	6	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3370	012	0	1	01	01	H3370_012_0	6	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3370	012	0	1	01	01	H3370_012_0	6	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3370	012	0	1	01	01	H3370_012_0	6	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									4
H3370	012	0	1	01	01	H3370_012_0	6	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3370	014	0	1	01	01	H3370_014_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	24.00								8.00				16.00									4
H3370	014	0	1	01	01	H3370_014_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3370	014	0	1	01	01	H3370_014_0	4	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3370	014	0	1	01	01	H3370_014_0	4	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3370	014	0	1	01	01	H3370_014_0	4	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	24.00								8.00				16.00								1	4
H3370	014	0	1	01	01	H3370_014_0	4	3	3	Formulary Brand	100010	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H3370	014	0	1	01	01	H3370_014_0	4	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H3370	014	0	1	01	01	H3370_014_0	4	4	3	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand																							Specialty Formulary Brand					Specialty Formulary Brand																						Specialty Formulary Brand																						2	4
H3370	016	0	1	01	01	H3370_016_0	6	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									4
H3370	016	0	1	01	01	H3370_016_0	6	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	90.00								30.00				60.00									4
H3370	016	0	1	01	01	H3370_016_0	6	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	75.00	225.00								75.00				150.00									4
H3370	016	0	1	01	01	H3370_016_0	6	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H3370	020	0	1	01	01	H3370_020_0	6	3	1	Formulary Brand	100010		2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	80.00	240.00								80.00				160.00									3
H3370	020	0	1	01	01	H3370_020_0	6	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	37.00	111.00								37.00				74.00									3
H3370	020	0	1	01	01	H3370_020_0	6	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00				20.00									3
H3370	020	0	1	01	01	H3370_020_0	6	4	1	Specialty Formulary Brand	000010		1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							3
H3379	001	0	1	01	01	H3379_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3379	001	0	1	01	01	H3379_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3379	001	0	1	01	01	H3379_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3379	001	0	1	01	01	H3379_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3379	002	0	1	01	01	H3379_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3379	002	0	1	01	01	H3379_002_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3379	002	0	1	01	01	H3379_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3379	002	0	1	01	01	H3379_002_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3379	005	0	1	01	01	H3379_005_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3379	005	0	1	01	01	H3379_005_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3379	005	0	1	01	01	H3379_005_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3379	005	0	1	01	01	H3379_005_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3379	007	0	1	01	01	H3379_007_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3379	007	0	1	01	01	H3379_007_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3379	007	0	1	01	01	H3379_007_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3379	007	0	1	01	01	H3379_007_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3379	012	0	1	01	01	H3379_012_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3379	012	0	1	01	01	H3379_012_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3379	012	0	1	01	01	H3379_012_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3379	012	0	1	01	01	H3379_012_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3379	022	0	1	01	01	H3379_022_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3379	022	0	1	01	01	H3379_022_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3379	022	0	1	01	01	H3379_022_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3379	022	0	1	01	01	H3379_022_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3379	024	0	1	02	01	H3379_024_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3379	024	0	1	02	01	H3379_024_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3379	024	0	1	02	01	H3379_024_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3379	024	0	1	02	01	H3379_024_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3384	013	0	1	01	01	H3384_013_0	7	4	1	Specialty Injectibles	100001		1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							3
H3384	013	0	1	01	01	H3384_013_0	7	3	1	Non-Preferred Brand/Generic	100100		2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							3
H3384	013	0	1	01	01	H3384_013_0	7	2	1	Formulary Brand	000001		2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									3
H3384	013	0	1	01	01	H3384_013_0	7	1	1	Formulary Generic	001000		2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00									3
H3384	019	0	1	01	01	H3384_019_0	6	3	1	Non-Preferred Brand/Generic	100100	1	2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							4
H3384	019	0	1	01	01	H3384_019_0	6	2	1	Formulary Brand	000001	1	2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									4
H3384	019	0	1	01	01	H3384_019_0	6	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00	0.00		0.00	0.00									4
H3384	019	0	1	01	01	H3384_019_0	6	4	1	Specialty Injectibles	100001	1	1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							4
H3384	040	0	1	01	01	H3384_040_0	5	1	3	Formulary Generic	001000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00								1	4
H3384	040	0	1	01	01	H3384_040_0	5	2	3	Formulary Brand	000001	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H3384	040	0	1	01	01	H3384_040_0	5	3	3	Non-Preferred Brand/Generic	100100	1	2	Non-Preferred Brand/Generic																							Non-Preferred Brand/Generic					Non-Preferred Brand/Generic																						Non-Preferred Brand/Generic																						2	4
H3384	040	0	1	01	01	H3384_040_0	5	4	3	Specialty Injectibles	100001	1	1	Specialty Injectibles																							Specialty Injectibles					Specialty Injectibles																						Specialty Injectibles																						2	4
H3384	040	0	1	01	01	H3384_040_0	5	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00									4
H3384	040	0	1	01	01	H3384_040_0	5	2	1	Formulary Brand	000001	1	2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									4
H3384	040	0	1	01	01	H3384_040_0	5	4	1	Specialty Injectibles	100001	1	1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							4
H3384	040	0	1	01	01	H3384_040_0	5	3	1	Non-Preferred Brand/Generic	100100	1	2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							4
H3384	041	0	1	01	01	H3384_041_0	5	1	3	Formulary Generic	001000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00	0.00		0.00	0.00								1	4
H3384	041	0	1	01	01	H3384_041_0	5	2	3	Formulary Brand	000001	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H3384	041	0	1	01	01	H3384_041_0	5	3	3	Non-Preferred Brand/Generic	100100	1	2	Non-Preferred Brand/Generic																							Non-Preferred Brand/Generic					Non-Preferred Brand/Generic																						Non-Preferred Brand/Generic																						2	4
H3384	041	0	1	01	01	H3384_041_0	5	4	3	Specialty Injectibles	100001	1	1	Specialty Injectibles																							Specialty Injectibles					Specialty Injectibles																						Specialty Injectibles																						2	4
H3384	041	0	1	01	01	H3384_041_0	5	3	1	Non-Preferred Brand/Generic	100100	1	2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							4
H3384	041	0	1	01	01	H3384_041_0	5	4	1	Specialty Injectibles	100001	1	1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							4
H3384	041	0	1	01	01	H3384_041_0	5	2	1	Formulary Brand	000001	1	2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									4
H3384	041	0	1	01	01	H3384_041_0	5	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00	0.00		0.00	0.00									4
H3384	052	0	1	01	01	H3384_052_0	4	4	1	Specialty Injectibles	100001		1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							3
H3384	052	0	1	01	01	H3384_052_0	4	3	1	Non-Preferred Brand/Generic	100100		2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							3
H3384	052	0	1	01	01	H3384_052_0	4	2	1	Formulary Brand	000001		2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									3
H3384	052	0	1	01	01	H3384_052_0	4	1	1	Formulary Generic	001000		2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00									3
H3384	053	0	1	01	01	H3384_053_0	7	3	1	Non-Preferred Brand/Generic	100100		2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							3
H3384	053	0	1	01	01	H3384_053_0	7	4	1	Specialty Injectibles	100001		1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							3
H3384	053	0	1	01	01	H3384_053_0	7	2	1	Formulary Brand	000001		2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									3
H3384	053	0	1	01	01	H3384_053_0	7	1	1	Formulary Generic	001000		2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00									3
H3388	002	0	1	01	01	H3388_002_0	2	4	1	Tier 4 Formulary Brand Specialty	000010	1	1	Tier 4 Formulary Brand Specialty	010000000010010000000	30									30			30									Tier 4 Formulary Brand Specialty	2	1	010000000010010000000		Tier 4 Formulary Brand Specialty	25									25			25									Tier 4 Formulary Brand Specialty																							4
H3388	002	0	1	01	01	H3388_002_0	2	3	1	Tier 3 Formulary Brand	000010	1	2	Tier 3 Formulary Brand	011000000010011000000	30	90								30			30	90								Tier 3 Formulary Brand	2	2		011000000010011000000	Tier 3 Formulary Brand																						Tier 3 Formulary Brand	50.00	150.00								50.00			50.00	100.00									4
H3388	002	0	1	01	01	H3388_002_0	2	2	1	Tier 2 Formulary Preferred Brand	000001	1	2	Tier 2 Formulary Preferred Brand	011000000010011000000	30	90								30			30	90								Tier 2 Formulary Preferred Brand	2	2		011000000010011000000	Tier 2 Formulary Preferred Brand																						Tier 2 Formulary Preferred Brand	35.00	105.00								35.00			35.00	70.00									4
H3388	002	0	1	01	01	H3388_002_0	2	1	1	Tier 1 Formulary Generic	010000	1	2	Tier 1 Formulary Generic	011000000010011000000	30	90								30			30	90								Tier 1 Formulary Generic	2	2		011000000010011000000	Tier 1 Formulary Generic																						Tier 1 Formulary Generic	5.00	15.00								5.00			5.00	10.00									4
H3388	004	0	1	01	01	H3388_004_0	2	1	1	Tier 1 Formulary Generic	010000	1	2	Tier 1 Formulary Generic	011000000010011000000	30	90								30			30	90								Tier 1 Formulary Generic	2	2		011000000010011000000	Tier 1 Formulary Generic																						Tier 1 Formulary Generic	10.00	30.00								10.00			10.00	20.00									4
H3388	004	0	1	01	01	H3388_004_0	2	2	1	Tier 2 Formulary Preferred Brand	000001	1	2	Tier 2 Formulary Preferred Brand	011000000010011000000	30	90								30			30	90								Tier 2 Formulary Preferred Brand	2	2		011000000010011000000	Tier 2 Formulary Preferred Brand																						Tier 2 Formulary Preferred Brand	35.00	105.00								35.00			35.00	70.00									4
H3388	004	0	1	01	01	H3388_004_0	2	3	1	Tier 3 Formulary Brand	000010	1	2	Tier 3 Formulary Brand	011000000010011000000	30	90								30			30	90								Tier 3 Formulary Brand	2	2		011000000010011000000	Tier 3 Formulary Brand																						Tier 3 Formulary Brand	55.00	165.00								55.00			55.00	110.00									4
H3388	004	0	1	01	01	H3388_004_0	2	4	1	Tier 4 Formulary Brand Specialty	000010	1	1	Tier 4 Formulary Brand Specialty	010000000010010000000	30									30			30									Tier 4 Formulary Brand Specialty	2	1	010000000010010000000		Tier 4 Formulary Brand Specialty	25									25			25									Tier 4 Formulary Brand Specialty																							4
H3404	001	0	1	04	01	H3404_001_0	1	1	1	Generic	010000	1	2	Generic	011100000010011100000	30	90	60							30			30	90	60							Generic	2	2		011100000010011100000	Generic																						Generic	5.00	15.00	10.00							5.00			5.00	15.00	10.00								4
H3404	001	0	1	04	01	H3404_001_0	1	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H3404	001	0	1	04	01	H3404_001_0	1	1	3	Generic	010000	1	2	Generic	011100000010011100000	30	90	60							30			30	90	60							Generic	2	2		011100000010011100000	Generic																						Generic	5.00	15.00	10.00							5.00			5.00	15.00	10.00							1	4
H3404	001	0	1	04	01	H3404_001_0	1	3	1	Specialty	010010	1	1	Specialty	011100000010011100000	30	90	60							30			30	90	60							Specialty	2	1	011100000010011100000		Specialty	25	25	25							25			25	25	25							Specialty																							4
H3404	001	0	1	04	01	H3404_001_0	1	3	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H3404	001	0	1	04	01	H3404_001_0	1	2	1	Brand	000010	1	2	Brand	011100000010011100000	30	90	60							30			30	90	60							Brand	2	2		011100000010011100000	Brand																						Brand	30.00	90.00	60.00							30.00			30.00	90.00	60.00								4
H3405	001	0	1	04	01	H3405_001_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H3405	001	0	1	04	01	H3405_001_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H3405	001	0	1	04	01	H3405_001_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H3405	001	0	1	04	01	H3405_001_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H3435	001	0	1	37	05	H3435_001_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H3435	001	0	1	37	05	H3435_001_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H3435	001	0	1	37	05	H3435_001_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H3435	001	0	1	37	05	H3435_001_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3435	003	0	1	37	05	H3435_003_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H3435	003	0	1	37	05	H3435_003_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H3435	003	0	1	37	05	H3435_003_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H3435	003	0	1	37	05	H3435_003_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3449	005	0	1	01	01	H3449_005_0	2	3	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H3449	005	0	1	01	01	H3449_005_0	2	1	3	Generic	010000	1	2	Generic	011100000010011100000	30	90	60							30			30	90	60							Generic	2	2		011100000010011100000	Generic																						Generic	5.00	15.00	10.00							5.00			5.00	15.00	10.00							1	4
H3449	005	0	1	01	01	H3449_005_0	2	3	1	Specialty	010010	1	1	Specialty	011100000010011100000	30	90	60							30			30	90	60							Specialty	2	1	011100000010011100000		Specialty	25	25	25							25			25	25	25							Specialty																							4
H3449	005	0	1	01	01	H3449_005_0	2	2	1	Brand	000010	1	2	Brand	011100000010011100000	30	90	60							30			30	90	60							Brand	2	2		011100000010011100000	Brand																						Brand	30.00	90.00	60.00							30.00			30.00	90.00	60.00								4
H3449	005	0	1	01	01	H3449_005_0	2	1	1	Generic	010000	1	2	Generic	011100000010011100000	30	90	60							30			30	90	60							Generic	2	2		011100000010011100000	Generic																						Generic	5.00	15.00	10.00							5.00			5.00	15.00	10.00								4
H3449	005	0	1	01	01	H3449_005_0	2	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H3456	001	0	1	01	01	H3456_001_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3456	001	0	1	01	01	H3456_001_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3456	001	0	1	01	01	H3456_001_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3456	001	0	1	01	01	H3456_001_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3456	010	0	1	01	01	H3456_010_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3456	010	0	1	01	01	H3456_010_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3456	010	0	1	01	01	H3456_010_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3456	010	0	1	01	01	H3456_010_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3456	016	0	1	01	01	H3456_016_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3456	016	0	1	01	01	H3456_016_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H3456	016	0	1	01	01	H3456_016_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3456	016	0	1	01	01	H3456_016_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3619	001	0	1	04	01	H3619_001_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H3619	001	0	1	04	01	H3619_001_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H3619	001	0	1	04	01	H3619_001_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H3619	001	0	1	04	01	H3619_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H3619	004	0	1	04	01	H3619_004_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H3619	004	0	1	04	01	H3619_004_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H3619	004	0	1	04	01	H3619_004_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H3619	004	0	1	04	01	H3619_004_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H3619	005	0	1	04	01	H3619_005_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H3619	005	0	1	04	01	H3619_005_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H3619	005	0	1	04	01	H3619_005_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H3619	005	0	1	04	01	H3619_005_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H3619	006	0	1	04	01	H3619_006_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H3619	006	0	1	04	01	H3619_006_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H3619	006	0	1	04	01	H3619_006_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H3619	006	0	1	04	01	H3619_006_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H3620	001	0	1	04	01	H3620_001_0	4	1	1	Generic	010000	1	2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00								4
H3620	001	0	1	04	01	H3620_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Preferred Brand	2	2		000010110110100100000	Preferred Brand																						Preferred Brand				20.00		40.00	20.00		40.00	20.00		40.00			40.00								4
H3620	001	0	1	04	01	H3620_001_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Non-Preferred Brand	2	2		000010110110100100000	Non-Preferred Brand																						Non-Preferred Brand				35.00		70.00	35.00		70.00	35.00		70.00			70.00								4
H3623	001	0	1	01	01	H3623_001_0	3	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H3623	001	0	1	01	01	H3623_001_0	3	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H3623	001	0	1	01	01	H3623_001_0	3	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H3623	002	0	1	01	01	H3623_002_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H3623	002	0	1	01	01	H3623_002_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H3623	002	0	1	01	01	H3623_002_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H3623	002	0	1	01	01	H3623_002_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H3623	002	0	1	01	01	H3623_002_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3623	002	0	1	01	01	H3623_002_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3623	002	0	1	01	01	H3623_002_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3623	002	0	1	01	01	H3623_002_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H3623	003	0	1	01	01	H3623_003_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3623	003	0	1	01	01	H3623_003_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3623	003	0	1	01	01	H3623_003_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H3623	003	0	1	01	01	H3623_003_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H3623	003	0	1	01	01	H3623_003_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H3623	003	0	1	01	01	H3623_003_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H3623	003	0	1	01	01	H3623_003_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H3623	003	0	1	01	01	H3623_003_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3623	004	0	1	01	01	H3623_004_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H3623	004	0	1	01	01	H3623_004_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H3623	004	0	1	01	01	H3623_004_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H3623	005	0	1	01	01	H3623_005_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H3623	005	0	1	01	01	H3623_005_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H3623	005	0	1	01	01	H3623_005_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3623	005	0	1	01	01	H3623_005_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3623	005	0	1	01	01	H3623_005_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H3623	005	0	1	01	01	H3623_005_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H3623	005	0	1	01	01	H3623_005_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H3623	005	0	1	01	01	H3623_005_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3623	006	0	1	01	01	H3623_006_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H3623	006	0	1	01	01	H3623_006_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H3623	006	0	1	01	01	H3623_006_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H3623	006	0	1	01	01	H3623_006_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H3623	006	0	1	01	01	H3623_006_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H3623	006	0	1	01	01	H3623_006_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3623	006	0	1	01	01	H3623_006_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3623	006	0	1	01	01	H3623_006_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3623	007	0	1	01	01	H3623_007_0	3	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H3623	007	0	1	01	01	H3623_007_0	3	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H3623	007	0	1	01	01	H3623_007_0	3	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H3623	008	0	1	01	01	H3623_008_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H3623	008	0	1	01	01	H3623_008_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H3623	008	0	1	01	01	H3623_008_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H3623	008	0	1	01	01	H3623_008_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3623	008	0	1	01	01	H3623_008_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3623	008	0	1	01	01	H3623_008_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3623	008	0	1	01	01	H3623_008_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H3623	008	0	1	01	01	H3623_008_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H3623	009	0	1	01	01	H3623_009_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H3623	009	0	1	01	01	H3623_009_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H3623	009	0	1	01	01	H3623_009_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H3623	009	0	1	01	01	H3623_009_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H3623	009	0	1	01	01	H3623_009_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H3623	009	0	1	01	01	H3623_009_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3623	009	0	1	01	01	H3623_009_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3623	009	0	1	01	01	H3623_009_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3623	010	0	1	01	01	H3623_010_0	3	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H3623	010	0	1	01	01	H3623_010_0	3	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	11.00	33.00								22.00							22.00			33.00			3
H3623	010	0	1	01	01	H3623_010_0	3	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H3623	011	0	1	01	01	H3623_011_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H3623	011	0	1	01	01	H3623_011_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3623	011	0	1	01	01	H3623_011_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3623	011	0	1	01	01	H3623_011_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3623	011	0	1	01	01	H3623_011_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H3623	011	0	1	01	01	H3623_011_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H3623	011	0	1	01	01	H3623_011_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H3623	011	0	1	01	01	H3623_011_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H3623	012	0	1	01	01	H3623_012_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H3623	012	0	1	01	01	H3623_012_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H3623	012	0	1	01	01	H3623_012_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3623	012	0	1	01	01	H3623_012_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H3623	012	0	1	01	01	H3623_012_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H3623	012	0	1	01	01	H3623_012_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H3623	012	0	1	01	01	H3623_012_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3623	012	0	1	01	01	H3623_012_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3624	001	0	1	04	01	H3624_001_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H3624	001	0	1	04	01	H3624_001_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H3624	001	0	1	04	01	H3624_001_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H3624	002	0	1	04	01	H3624_002_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H3624	002	0	1	04	01	H3624_002_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H3624	002	0	1	04	01	H3624_002_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H3653	004	0	1	01	01	H3653_004_0	6	3	1	Non-Preferred Brand	000100	1	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H3653	004	0	1	01	01	H3653_004_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	50.00								25.00			25.00	50.00									4
H3653	004	0	1	01	01	H3653_004_0	6	1	1	Generic	010000	1	2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	10.00								5.00			5.00	10.00									4
H3653	004	0	1	01	01	H3653_004_0	6	4	1	Multisource Brand (MSB) and Isomeric	000010	1	2	Multisource Brand (MSB) and Isomeric	010000000010000000000	30									30												Multisource Brand (MSB) and Isomeric	2	2		010000000010000000000	Multisource Brand (MSB) and Isomeric																						Multisource Brand (MSB) and Isomeric	50.00									50.00													4
H3653	004	0	1	01	01	H3653_004_0	6	5	1	Part D Eligible Injectable	010010	1	2	Part D Eligible Injectable	010000000010000000000	30									30												Part D Eligible Injectable	2	1	010000000010000000000		Part D Eligible Injectable	25									25												Part D Eligible Injectable																							4
H3653	004	0	1	01	01	H3653_004_0	6	6	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
H3653	015	0	1	01	01	H3653_015_0	4	3	1	Part D Eligible Injectable	010010		2	Part D Eligible Injectable	010000000010000000000	30									30												Part D Eligible Injectable	2	1	010000000010000000000		Part D Eligible Injectable	25									25												Part D Eligible Injectable																							3
H3653	015	0	1	01	01	H3653_015_0	4	2	1	Brand	000010		2	Brand	011000000010011000000	30	90								30			30	90								Brand	2	2		011000000010011000000	Brand																						Brand	40.00	80.00								40.00			40.00	80.00									3
H3653	015	0	1	01	01	H3653_015_0	4	1	1	Generic	010000		2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	6.00	12.00								6.00			6.00	12.00									3
H3653	015	0	1	01	01	H3653_015_0	4	4	1	Specialty	010010		1	Specialty	010000000010000000000	30									30												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							3
H3655	013	0	1	01	01	H3655_013_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H3655	013	0	1	01	01	H3655_013_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H3655	013	0	1	01	01	H3655_013_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H3655	013	0	1	01	01	H3655_013_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H3655	013	0	1	01	01	H3655_013_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H3655	013	0	1	01	01	H3655_013_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00		1	4
H3655	013	0	1	01	01	H3655_013_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3655	013	0	1	01	01	H3655_013_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3655	013	0	1	01	01	H3655_013_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H3655	013	0	1	01	01	H3655_013_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H3655	023	0	1	01	01	H3655_023_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H3655	023	0	1	01	01	H3655_023_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H3655	023	0	1	01	01	H3655_023_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H3655	023	0	1	01	01	H3655_023_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H3655	023	0	1	01	01	H3655_023_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H3655	023	0	1	01	01	H3655_023_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00		1	4
H3655	023	0	1	01	01	H3655_023_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3655	023	0	1	01	01	H3655_023_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3655	023	0	1	01	01	H3655_023_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H3655	023	0	1	01	01	H3655_023_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H3659	001	0	1	02	01	H3659_001_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3659	001	0	1	02	01	H3659_001_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3659	001	0	1	02	01	H3659_001_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3659	001	0	1	02	01	H3659_001_0	8	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3659	003	0	1	01	01	H3659_003_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3659	003	0	1	01	01	H3659_003_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3659	003	0	1	01	01	H3659_003_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3659	003	0	1	01	01	H3659_003_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3659	031	0	1	01	01	H3659_031_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3659	031	0	1	01	01	H3659_031_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3659	031	0	1	01	01	H3659_031_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3659	031	0	1	01	01	H3659_031_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3659	033	0	1	02	01	H3659_033_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3659	033	0	1	02	01	H3659_033_0	8	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3659	033	0	1	02	01	H3659_033_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3659	033	0	1	02	01	H3659_033_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3659	056	0	1	01	01	H3659_056_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3659	056	0	1	01	01	H3659_056_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H3659	056	0	1	01	01	H3659_056_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3659	056	0	1	01	01	H3659_056_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3659	057	0	1	01	01	H3659_057_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3659	057	0	1	01	01	H3659_057_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3659	057	0	1	01	01	H3659_057_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3659	057	0	1	01	01	H3659_057_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3659	058	0	1	01	01	H3659_058_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3659	058	0	1	01	01	H3659_058_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3659	058	0	1	01	01	H3659_058_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3659	058	0	1	01	01	H3659_058_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3660	028	0	1	02	01	H3660_028_0	5	1	1	TIER I	010000	1	2	TIER I	011000000010001000000	30	90								30				90								TIER I	2	2		011000000010001000000	TIER I																						TIER I	3.00	9.00								3.00				7.50									4
H3660	028	0	1	02	01	H3660_028_0	5	2	1	TIER II	000001	1	2	TIER II	011000000010001000000	30	90								30				90								TIER II	2	2		011000000010001000000	TIER II																						TIER II	30.00	90.00								30.00				75.00									4
H3660	028	0	1	02	01	H3660_028_0	5	3	1	TIER III	100000	1	2	TIER III	011000000010001000000	30	90								30				90								TIER III	2	2		011000000010001000000	TIER III																						TIER III	60.00	180.00								60.00				180.00									4
H3660	028	0	1	02	01	H3660_028_0	5	4	1	Tier IV	000010	1	1	Tier IV	011000000010001000000	30	90								30				90								Tier IV	2	1	011000000010001000000		Tier IV	25	25								25				25								Tier IV																							4
H3660	028	0	1	02	01	H3660_028_0	5	1	3	TIER I	010000	1	2	TIER I	011000000010001000000	30	90								30				90								TIER I	2	2		011000000010001000000	TIER I																						TIER I	3.00	9.00								3.00				7.50								1	4
H3660	028	0	1	02	01	H3660_028_0	5	2	3	TIER II	000001	1	2	TIER II																							TIER II					TIER II																						TIER II																						2	4
H3660	028	0	1	02	01	H3660_028_0	5	3	3	TIER III	100000	1	2	TIER III																							TIER III					TIER III																						TIER III																						2	4
H3660	028	0	1	02	01	H3660_028_0	5	4	3	Tier IV	000010	1	1	Tier IV																							Tier IV					Tier IV																						Tier IV																						2	4
H3660	029	0	1	02	01	H3660_029_0	5	1	1	TIER I	010000	1	2	TIER I	011000000010001000000	30	90								30				90								TIER I	2	2		011000000010001000000	TIER I																						TIER I	3.00	9.00								3.00				7.50									4
H3660	029	0	1	02	01	H3660_029_0	5	2	1	TIER II	000001	1	2	TIER II	011000000010001000000	30	90								30				90								TIER II	2	2		011000000010001000000	TIER II																						TIER II	30.00	90.00								30.00				75.00									4
H3660	029	0	1	02	01	H3660_029_0	5	4	3	Tier IV	000010	1	1	Tier IV																							Tier IV					Tier IV																						Tier IV																						2	4
H3660	029	0	1	02	01	H3660_029_0	5	3	3	TIER III	100000	1	2	TIER III																							TIER III					TIER III																						TIER III																						2	4
H3660	029	0	1	02	01	H3660_029_0	5	3	1	TIER III	100000	1	2	TIER III	011000000010001000000	30	90								30				90								TIER III	2	2		011000000010001000000	TIER III																						TIER III	60.00	180.00								60.00				180.00									4
H3660	029	0	1	02	01	H3660_029_0	5	4	1	Tier IV	000010	1	1	Tier IV	011000000010001000000	30	90								30				90								Tier IV	2	1	011000000010001000000		Tier IV	25	25								25				25								Tier IV																							4
H3660	029	0	1	02	01	H3660_029_0	5	1	3	TIER I	010000	1	2	TIER I	011000000010001000000	30	90								30				90								TIER I	2	2		011000000010001000000	TIER I																						TIER I	3.00	9.00								3.00				7.50								1	4
H3660	029	0	1	02	01	H3660_029_0	5	2	3	TIER II	000001	1	2	TIER II																							TIER II					TIER II																						TIER II																						2	4
H3664	001	0	1	01	01	H3664_001_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Preferred Brand	2	2		000010110110100100000	Preferred Brand																						Preferred Brand				20.00		40.00	20.00		40.00	20.00		40.00			40.00								4
H3664	001	0	1	01	01	H3664_001_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Non-Preferred Brand	2	2		000010110110100100000	Non-Preferred Brand																						Non-Preferred Brand				35.00		70.00	35.00		70.00	35.00		70.00			70.00								4
H3664	001	0	1	01	01	H3664_001_0	5	1	1	Generic	010000	1	2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00								4
H3664	008	0	2	01	01	H3664_008_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Preferred Brand	2	2		000010110110100100000	Preferred Brand																						Preferred Brand				20.00		40.00	20.00		40.00	20.00		40.00			40.00								4
H3664	008	0	2	01	01	H3664_008_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Non-Preferred Brand	2	2		000010110110100100000	Non-Preferred Brand																						Non-Preferred Brand				35.00		70.00	35.00		70.00	35.00		70.00			70.00								4
H3664	008	0	2	01	01	H3664_008_0	5	1	1	Generic	010000	1	2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00								4
H3664	009	0	1	01	01	H3664_009_0	6	1	1	Generic	010000	1	2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00								4
H3664	009	0	1	01	01	H3664_009_0	6	2	1	Preferred  Brand	000001	1	2	Preferred  Brand	000010110110100100000				30		60	30		60	30		60			60							Preferred  Brand	2	2		000010110110100100000	Preferred  Brand																						Preferred  Brand				20.00		40.00	20.00		40.00	20.00		40.00			40.00								4
H3664	009	0	1	01	01	H3664_009_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Non-Preferred Brand	2	2		000010110110100100000	Non-Preferred Brand																						Non-Preferred Brand				35.00		70.00	35.00		70.00	35.00		70.00			70.00								4
H3664	011	0	1	01	01	H3664_011_0	7	1	1	Generic	010000	1	2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00								4
H3664	011	0	1	01	01	H3664_011_0	7	2	1	Preferred  Brand	000001	1	2	Preferred  Brand	000010110110100100000				30		60	30		60	30		60			60							Preferred  Brand	2	2		000010110110100100000	Preferred  Brand																						Preferred  Brand				20.00		40.00	20.00		40.00	20.00		40.00			40.00								4
H3664	011	0	1	01	01	H3664_011_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Non-Preferred Brand	2	2		000010110110100100000	Non-Preferred Brand																						Non-Preferred Brand				35.00		70.00	35.00		70.00	35.00		70.00			70.00								4
H3664	012	0	1	01	01	H3664_012_0	6	1	1	Generic	010000	1	2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00								4
H3664	012	0	1	01	01	H3664_012_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Preferred Brand	2	2		000010110110100100000	Preferred Brand																						Preferred Brand				20.00		40.00	20.00		40.00	20.00		40.00			40.00								4
H3664	012	0	1	01	01	H3664_012_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Non-Preferred Brand	2	2		000010110110100100000	Non-Preferred Brand																						Non-Preferred Brand				35.00		70.00	35.00		70.00	35.00		70.00			70.00								4
H3664	013	0	1	01	01	H3664_013_0	6	1	3	Generic	010000	1	2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00							1	4
H3664	013	0	1	01	01	H3664_013_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3664	013	0	1	01	01	H3664_013_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3664	013	0	1	01	01	H3664_013_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Non-Preferred Brand	2	2		000010110110100100000	Non-Preferred Brand																						Non-Preferred Brand				35.00		70.00	35.00		70.00	35.00		70.00			70.00								4
H3664	013	0	1	01	01	H3664_013_0	6	1	1	Generic	010000	1	2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00								4
H3664	013	0	1	01	01	H3664_013_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Preferred Brand	2	2		000010110110100100000	Preferred Brand																						Preferred Brand				20.00		40.00	20.00		40.00	20.00		40.00			40.00								4
H3668	005	0	1	01	01	H3668_005_0	4	4	1	Specialty Drugs	000010	1	1	Specialty Drugs	011000000011000011011	30	90								30	90					30	90		30	90		Specialty Drugs	1	1	011000000011000011011		Specialty Drugs	25	25								25	25					25	25		25	25		Specialty Drugs																							4
H3668	005	0	1	01	01	H3668_005_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3668	005	0	1	01	01	H3668_005_0	4	4	3	Specialty Drugs	000010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3668	005	0	1	01	01	H3668_005_0	4	1	3	Generic	010000	1	2	Generic	011000000011000011011	30	90								30	90					30	90		30	90		Generic	1	2		011000000011000011011	Generic																						Generic	10.00	30.00								10.00	30.00					10.00	20.00		10.00	20.00		1	4
H3668	005	0	1	01	01	H3668_005_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3668	005	0	1	01	01	H3668_005_0	4	1	1	Generic	010000	1	2	Generic	011000000011000011011	30	90								30	90					30	90		30	90		Generic	1	2		011000000011000011011	Generic																						Generic	10.00	30.00								10.00	30.00					10.00	20.00		10.00	20.00			4
H3668	005	0	1	01	01	H3668_005_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000011011	30	90								30	90					30	90		30	90		Preferred Brand	1	2		011000000011000011011	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00					20.00	40.00		20.00	40.00			4
H3668	005	0	1	01	01	H3668_005_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000011011	30	90								30	90					30	90		30	90		Non-Preferred Brand	1	2		011000000011000011011	Non-Preferred Brand																						Non-Preferred Brand	35.00	105.00								35.00	105.00					35.00	70.00		35.00	70.00			4
H3668	010	0	1	01	01	H3668_010_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000011011	30	90								30	90					30	90		30	90		Preferred Brand	1	2		011000000011000011011	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00					20.00	40.00		20.00	40.00			4
H3668	010	0	1	01	01	H3668_010_0	4	1	1	Generic	010000	1	2	Generic	011000000011000011011	30	90								30	90					30	90		30	90		Generic	1	2		011000000011000011011	Generic																						Generic	10.00	30.00								10.00	30.00					10.00	20.00		10.00	20.00			4
H3668	010	0	1	01	01	H3668_010_0	4	4	3	Specialty Drugs	000010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3668	010	0	1	01	01	H3668_010_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3668	010	0	1	01	01	H3668_010_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3668	010	0	1	01	01	H3668_010_0	4	1	3	Generic	010000	1	2	Generic	011000000011000011011	30	90								30	90					30	90		30	90		Generic	1	2		011000000011000011011	Generic																						Generic	10.00	30.00								10.00	30.00					10.00	20.00		10.00	20.00		1	4
H3668	010	0	1	01	01	H3668_010_0	4	4	1	Specialty Drugs	000010	1	1	Specialty Drugs	011000000011000011011	30	90								30	90					30	90		30	90		Specialty Drugs	1	1	011000000011000011011		Specialty Drugs	25	25								25	25					25	25		25	25		Specialty Drugs																							4
H3668	010	0	1	01	01	H3668_010_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000011011	30	90								30	90					30	90		30	90		Non-Preferred Brand	1	2		011000000011000011011	Non-Preferred Brand																						Non-Preferred Brand	35.00	105.00								35.00	105.00					35.00	70.00		35.00	70.00			4
H3668	011	0	1	01	01	H3668_011_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000011011	30	90								30	90					30	90		30	90		Preferred Brand	1	2		011000000011000011011	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00					20.00	40.00		20.00	40.00			4
H3668	011	0	1	01	01	H3668_011_0	5	1	1	Generic	010000	1	2	Generic	011000000011000011011	30	90								30	90					30	90		30	90		Generic	1	2		011000000011000011011	Generic																						Generic	10.00	30.00								10.00	30.00					10.00	20.00		10.00	20.00			4
H3668	011	0	1	01	01	H3668_011_0	5	4	1	Specialty Drugs	000010	1	1	Specialty Drugs	011000000011000011011	30	90								30	90					30	90		30	90		Specialty Drugs	1	1	011000000011000011011		Specialty Drugs	25	25								25	25					25	25		25	25		Specialty Drugs																							4
H3668	011	0	1	01	01	H3668_011_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000011011	30	90								30	90					30	90		30	90		Non-Preferred Brand	1	2		011000000011000011011	Non-Preferred Brand																						Non-Preferred Brand	35.00	105.00								35.00	105.00					35.00	70.00		35.00	70.00			4
H3668	012	0	1	01	01	H3668_012_0	5	1	1	Generic	010000	1	2	Generic	011000000011000011011	30	90								30	90					30	90		30	90		Generic	1	2		011000000011000011011	Generic																						Generic	10.00	30.00								10.00	30.00					10.00	20.00		10.00	20.00			4
H3668	012	0	1	01	01	H3668_012_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000011011	30	90								30	90					30	90		30	90		Non-Preferred Brand	1	2		011000000011000011011	Non-Preferred Brand																						Non-Preferred Brand	35.00	105.00								35.00	105.00					35.00	70.00		35.00	70.00			4
H3668	012	0	1	01	01	H3668_012_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000011011	30	90								30	90					30	90		30	90		Preferred Brand	1	2		011000000011000011011	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00					20.00	40.00		20.00	40.00			4
H3668	012	0	1	01	01	H3668_012_0	5	4	1	Specialty Drugs	000010	1	1	Specialty Drugs	011000000011000011011	30	90								30	90					30	90		30	90		Specialty Drugs	1	1	011000000011000011011		Specialty Drugs	25	25								25	25					25	25		25	25		Specialty Drugs																							4
H3672	013	0	1	01	01	H3672_013_0	6	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	9.00	27.00								9.00	27.00			18.00									4
H3672	013	0	1	01	01	H3672_013_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00	105.00			70.00									4
H3672	013	0	1	01	01	H3672_013_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	1	011000000011001000000		Non-Preferred Brand	50	50								50	50			50								Non-Preferred Brand																							4
H3672	013	0	1	01	01	H3672_013_0	6	4	3	Specialty	010001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H3672	013	0	1	01	01	H3672_013_0	6	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	15.00	45.00								15.00	45.00			30.00								1	4
H3672	013	0	1	01	01	H3672_013_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3672	013	0	1	01	01	H3672_013_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3672	013	0	1	01	01	H3672_013_0	6	4	1	Specialty	010001	1	1	Specialty	011000000011010000000	30	90								30	90		30									Specialty	1	1	011000000011010000000		Specialty	20	20								20	20		20									Specialty																							4
H3706	001	0	1	01	01	H3706_001_0	4	3	1	All Other Medicare Part D	100000	1	2	All Other Medicare Part D	011000000000101000000	30	90										10		90								All Other Medicare Part D	2	2		011000000000101000000	All Other Medicare Part D																						All Other Medicare Part D	40.00	120.00										40.00		80.00									4
H3706	001	0	1	01	01	H3706_001_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000000101000000	30	90										10		90								Formulary Preferred Brand	2	2		011000000000101000000	Formulary Preferred Brand																						Formulary Preferred Brand	20.00	60.00										20.00		40.00									4
H3706	001	0	1	01	01	H3706_001_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000000101000000	30	90										10		90								Formulary Generic	2	2		011000000000101000000	Formulary Generic																						Formulary Generic	5.00	15.00										5.00		10.00									4
H3706	001	0	1	01	01	H3706_001_0	4	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000000101000000	30	90										10		90								Formulary Specialty	2	1	011000000000101000000		Formulary Specialty	25	25										25		25								Formulary Specialty																							4
H3706	006	0	1	01	01	H3706_006_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000000101000000	30	90										10		90								Formulary Preferred Brand	2	2		011000000000101000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00										25.00		50.00									4
H3706	006	0	1	01	01	H3706_006_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000000101000000	30	90										10		90								Formulary Generic	2	2		011000000000101000000	Formulary Generic																						Formulary Generic	10.00	30.00										10.00		20.00									4
H3706	006	0	1	01	01	H3706_006_0	4	3	1	All Other Medicare Part D	100000	1	2	All Other Medicare Part D	011000000000101000000	30	90										10		90								All Other Medicare Part D	2	2		011000000000101000000	All Other Medicare Part D																						All Other Medicare Part D	45.00	135.00										45.00		90.00									4
H3706	006	0	1	01	01	H3706_006_0	4	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000000101000000	30	90										10		90								Formulary Specialty	2	1	011000000000101000000		Formulary Specialty	25	25										25		25								Formulary Specialty																							4
H3706	007	0	1	02	01	H3706_007_0	4	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000000101000000	30	90										10		90								Formulary Specialty	2	1	011000000000101000000		Formulary Specialty	25	25										25		25								Formulary Specialty																							4
H3706	007	0	1	02	01	H3706_007_0	4	3	1	All Other Medicare Part D	100000	1	2	All Other Medicare Part D	011000000000101000000	30	90										10		90								All Other Medicare Part D	2	2		011000000000101000000	All Other Medicare Part D																						All Other Medicare Part D	40.00	120.00										40.00		80.00									4
H3706	007	0	1	02	01	H3706_007_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000000101000000	30	90										10		90								Formulary Preferred Brand	2	2		011000000000101000000	Formulary Preferred Brand																						Formulary Preferred Brand	20.00	60.00										20.00		40.00									4
H3706	007	0	1	02	01	H3706_007_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000000101000000	30	90										10		90								Formulary Generic	2	2		011000000000101000000	Formulary Generic																						Formulary Generic	5.00	15.00										5.00		10.00									4
H3706	008	0	1	02	01	H3706_008_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000000101000000	30	90										10		90								Formulary Generic	2	2		011000000000101000000	Formulary Generic																						Formulary Generic	10.00	30.00										10.00		20.00									4
H3706	008	0	1	02	01	H3706_008_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000000101000000	30	90										10		90								Formulary Preferred Brand	2	2		011000000000101000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00										25.00		50.00									4
H3706	008	0	1	02	01	H3706_008_0	4	3	1	All Other Medicare Part D	100000	1	2	All Other Medicare Part D	011000000000101000000	30	90										10		90								All Other Medicare Part D	2	2		011000000000101000000	All Other Medicare Part D																						All Other Medicare Part D	45.00	135.00										45.00		90.00									4
H3706	008	0	1	02	01	H3706_008_0	4	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000000101000000	30	90										10		90								Formulary Specialty	2	1	011000000000101000000		Formulary Specialty	25	25										25		25								Formulary Specialty																							4
H3709	001	0	1	04	01	H3709_001_0	5	5	1	Specialty injectables	010010		1	Specialty injectables	011000000010011000000	30	90								30			30	90								Specialty injectables	1	1	011000000010011000000		Specialty injectables	30	30								30			30	30								Specialty injectables																							3
H3709	001	0	1	04	01	H3709_001_0	5	4	1	Non-specialty Injectables	010010		2	Non-specialty Injectables	011000000010011000000	30	90								30			30	90								Non-specialty Injectables	1	1	011000000010011000000		Non-specialty Injectables	30	30								30			30	30								Non-specialty Injectables																							3
H3709	001	0	1	04	01	H3709_001_0	5	3	1	Non-Preferred Brand and Non-Preferred Generic	100100		2	Non-Preferred Brand and Non-Preferred Generic	011000000010011000000	30	90								30			30	90								Non-Preferred Brand and Non-Preferred Generic	1	2		011000000010011000000	Non-Preferred Brand and Non-Preferred Generic																						Non-Preferred Brand and Non-Preferred Generic	57.00	171.00								57.00			57.00	171.00									3
H3709	001	0	1	04	01	H3709_001_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	1	2		011000000010011000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00			7.00	21.00									3
H3709	001	0	1	04	01	H3709_001_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	28.00	84.00								28.00			28.00	84.00									3
H3749	001	0	1	01	01	H3749_001_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H3749	001	0	1	01	01	H3749_001_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H3749	001	0	1	01	01	H3749_001_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H3749	001	0	1	01	01	H3749_001_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H3749	004	0	1	01	01	H3749_004_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H3749	004	0	1	01	01	H3749_004_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H3749	004	0	1	01	01	H3749_004_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H3749	004	0	1	01	01	H3749_004_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H3749	011	0	1	01	01	H3749_011_0	6	3	1	Tier 3 Non-Preferred	000010		2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			3
H3749	011	0	1	01	01	H3749_011_0	6	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H3749	011	0	1	01	01	H3749_011_0	6	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			3
H3749	011	0	1	01	01	H3749_011_0	6	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H3755	001	0	1	01	01	H3755_001_0	5	5	1	Non-Special Injectables	010010		2	Non-Special Injectables	011000000010011000000	30	90								30			30	90								Non-Special Injectables	1	1	011000000010011000000		Non-Special Injectables	33	33								33			33	33								Non-Special Injectables																							3
H3755	001	0	1	01	01	H3755_001_0	5	4	1	Non Preferred Brand and Generic	100100		2	Non Preferred Brand and Generic	011000000010011000000	30	90								30			30	90								Non Preferred Brand and Generic	1	2		011000000010011000000	Non Preferred Brand and Generic																						Non Preferred Brand and Generic	60.00	180.00								60.00			60.00	180.00									3
H3755	001	0	1	01	01	H3755_001_0	5	3	1	Preferred Brand	000001		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	90.00									3
H3755	001	0	1	01	01	H3755_001_0	5	2	1	Preferred Generic	001000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	1	2		011000000010011000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00			7.00	21.00									3
H3755	001	0	1	01	01	H3755_001_0	5	6	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010011000000	30	90								30			30	90								Specialty Drugs	1	1	011000000010011000000		Specialty Drugs	33	33								33			33	33								Specialty Drugs																							3
H3755	001	0	1	01	01	H3755_001_0	5	1	1	Select Generics	001000		2	Select Generics	011000000010011000000	30	90								30			30	90								Select Generics	1	2		011000000010011000000	Select Generics																						Select Generics	0.00	0.00								0.00			0.00	0.00									3
H3755	004	0	1	01	01	H3755_004_0	3	5	1	Non-Special Injectables	010010		2	Non-Special Injectables	011000000010011000000	30	90								30			30	90								Non-Special Injectables	1	1	011000000010011000000		Non-Special Injectables	33	33								33			33	33								Non-Special Injectables																							3
H3755	004	0	1	01	01	H3755_004_0	3	4	1	Non Preferred Brand and Generic	100100		2	Non Preferred Brand and Generic	011000000010011000000	30	90								30			30	90								Non Preferred Brand and Generic	1	2		011000000010011000000	Non Preferred Brand and Generic																						Non Preferred Brand and Generic	60.00	180.00								60.00			60.00	180.00									3
H3755	004	0	1	01	01	H3755_004_0	3	3	1	Preferred Brand	000001		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	90.00									3
H3755	004	0	1	01	01	H3755_004_0	3	2	1	Preferred Generic	001000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	1	2		011000000010011000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00			7.00	21.00									3
H3755	004	0	1	01	01	H3755_004_0	3	1	1	Select Generics	001000		2	Select Generics	011000000010011000000	30	90								30			30	90								Select Generics	1	2		011000000010011000000	Select Generics																						Select Generics	0.00	0.00								0.00			0.00	0.00									3
H3755	004	0	1	01	01	H3755_004_0	3	6	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010011000000	30	90								30			30	90								Specialty Drugs	1	1	011000000010011000000		Specialty Drugs	33	33								33			33	33								Specialty Drugs																							3
H3805	001	0	1	01	01	H3805_001_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H3805	001	0	1	01	01	H3805_001_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H3805	001	0	1	01	01	H3805_001_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H3805	001	0	1	01	01	H3805_001_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H3805	007	0	1	01	01	H3805_007_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H3805	007	0	1	01	01	H3805_007_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H3805	007	0	1	01	01	H3805_007_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H3805	007	0	1	01	01	H3805_007_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H3810	003	0	1	01	01	H3810_003_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	29.00	87.00								29.00	87.00		29.00	87.00									4
H3810	003	0	1	01	01	H3810_003_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	15.00									4
H3810	003	0	1	01	01	H3810_003_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	49.00	147.00								49.00	147.00		49.00	147.00									4
H3810	003	0	1	01	01	H3810_003_0	4	4	1	Tier 4	010011	1	1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	2	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							4
H3810	005	0	1	02	01	H3810_005_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	29.00	87.00								29.00	87.00		29.00	87.00									4
H3810	005	0	1	02	01	H3810_005_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	15.00									4
H3810	005	0	1	02	01	H3810_005_0	5	4	1	Tier 4	010011	1	1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	2	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							4
H3810	005	0	1	02	01	H3810_005_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	49.00	147.00								49.00	147.00		49.00	147.00									4
H3811	002	0	1	01	01	H3811_002_0	3	3	1	Preferred Brands Tier	000001		2	Preferred Brands Tier	011000000011000000000	34	90								34	90											Preferred Brands Tier	2	2		011000000011000000000	Preferred Brands Tier																						Preferred Brands Tier	30.00	90.00								30.00	90.00												3
H3811	002	0	1	01	01	H3811_002_0	3	4	1	Specialty Tier	000011		1	Specialty Tier	011000000011000000000	34	90								34	90											Specialty Tier	2	1	011000000011000000000		Specialty Tier	25	25								25	25											Specialty Tier																							3
H3811	002	0	1	01	01	H3811_002_0	3	1	1	Therapeutic and OTC Tier	011011		2	Therapeutic and OTC Tier	011000000011000000000	34	90								34	90											Therapeutic and OTC Tier	2	2		011000000011000000000	Therapeutic and OTC Tier																						Therapeutic and OTC Tier	0.00	0.00								0.00	0.00												3
H3811	002	0	1	01	01	H3811_002_0	3	5	1	Non-Preferred Tier	100100		2	Non-Preferred Tier	011000000011000000000	34	90								34	90											Non-Preferred Tier	2	2		011000000011000000000	Non-Preferred Tier																						Non-Preferred Tier	60.00	180.00								60.00	180.00												3
H3811	002	0	1	01	01	H3811_002_0	3	2	1	Formulary Generics Tier	011000		2	Formulary Generics Tier	011000000011000000000	34	90								34	90											Formulary Generics Tier	2	2		011000000011000000000	Formulary Generics Tier																						Formulary Generics Tier	9.00	27.00								9.00	27.00												3
H3811	003	0	1	01	01	H3811_003_0	4	3	1	Preferred Brands Tier	000001		2	Preferred Brands Tier	011000000011000000000	34	90								34	90											Preferred Brands Tier	2	2		011000000011000000000	Preferred Brands Tier																						Preferred Brands Tier	40.00	120.00								40.00	120.00												3
H3811	003	0	1	01	01	H3811_003_0	4	4	1	Specialty Tier	000011		1	Specialty Tier	011000000011000000000	34	90								34	90											Specialty Tier	2	2		011000000011000000000	Specialty Tier																						Specialty Tier	50.00	150.00								50.00	150.00												3
H3811	003	0	1	01	01	H3811_003_0	4	5	1	Non-Preferred Tier	100100		2	Non-Preferred Tier	011000000011000000000	34	90								34	90											Non-Preferred Tier	2	2		011000000011000000000	Non-Preferred Tier																						Non-Preferred Tier	60.00	180.00								60.00	180.00												3
H3811	003	0	1	01	01	H3811_003_0	4	2	1	Formulary Generics Tier	011000		2	Formulary Generics Tier	011000000011000000000	34	90								34	90											Formulary Generics Tier	2	2		011000000011000000000	Formulary Generics Tier																						Formulary Generics Tier	10.00	30.00								10.00	30.00												3
H3811	003	0	1	01	01	H3811_003_0	4	1	1	Therapeutic and OTC Tier	011011		2	Therapeutic and OTC Tier	011000000011000000000	34	90								34	90											Therapeutic and OTC Tier	2	2		011000000011000000000	Therapeutic and OTC Tier																						Therapeutic and OTC Tier	0.00	0.00								0.00	0.00												3
H3812	001	0	1	04	01	H3812_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3812	001	0	1	04	01	H3812_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3812	001	0	1	04	01	H3812_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3812	001	0	1	04	01	H3812_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3812	004	0	1	04	01	H3812_004_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3812	004	0	1	04	01	H3812_004_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3812	004	0	1	04	01	H3812_004_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H3812	004	0	1	04	01	H3812_004_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3812	005	0	1	04	01	H3812_005_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H3812	005	0	1	04	01	H3812_005_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H3812	005	0	1	04	01	H3812_005_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H3812	005	0	1	04	01	H3812_005_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H3813	003	0	1	04	01	H3813_003_0	8	2	3	Brand/Preferred and Non-Preferred Brand/Specialty	100011	1	2	Brand/Preferred and Non-Preferred Brand/Specialty																							Brand/Preferred and Non-Preferred Brand/Specialty					Brand/Preferred and Non-Preferred Brand/Specialty																						Brand/Preferred and Non-Preferred Brand/Specialty																						2	4
H3813	003	0	1	04	01	H3813_003_0	8	1	3	Generic	011100	1	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	1	1	011000000011011000000		Generic	25	25								25	25		25	25								Generic																						1	4
H3814	004	0	1	01	01	H3814_004_0	6	3	1	Tier 3 Specialty	100100		1	Tier 3 Specialty	011000000011011000000	30	90								30	90		30	90								Tier 3 Specialty	2	2		011000000011011000000	Tier 3 Specialty																						Tier 3 Specialty	30.00	90.00								30.00	90.00		30.00	60.00									3
H3814	004	0	1	01	01	H3814_004_0	6	1	1	Tier One-Generic	001000		2	Tier One-Generic	011000000011011000000	30	90								30	90		30	90								Tier One-Generic	2	2		011000000011011000000	Tier One-Generic																						Tier One-Generic	6.00	18.00								6.00	18.00		6.00	12.00									3
H3814	004	0	1	01	01	H3814_004_0	6	2	1	Tier 2 - BRAND	000001		2	Tier 2 - BRAND	011000000011011000000	30	90								30	90		30	90								Tier 2 - BRAND	2	2		011000000011011000000	Tier 2 - BRAND																						Tier 2 - BRAND	30.00	90.00								30.00	90.00		30.00	60.00									3
H3814	006	0	1	01	01	H3814_006_0	5	1	1	ONE GENERICS	001000	1	2	ONE GENERICS	011000000011011000000	30	90								30	90		30	90								ONE GENERICS	2	2		011000000011011000000	ONE GENERICS																						ONE GENERICS	6.00	18.00								6.00	18.00		6.00	12.00									4
H3814	006	0	1	01	01	H3814_006_0	5	2	1	TWO-BRAND	000001	1	2	TWO-BRAND	011000000011011000000	30	90								30	90		30	90								TWO-BRAND	2	2		011000000011011000000	TWO-BRAND																						TWO-BRAND	30.00	90.00								30.00	90.00		30.00	60.00									4
H3814	006	0	1	01	01	H3814_006_0	5	3	1	THREE-SPECIALTY	100100	3	1	THREE-SPECIALTY	011000000011011000000	30	90								30	90		30	90								THREE-SPECIALTY	2	2		011000000011011000000	THREE-SPECIALTY																						THREE-SPECIALTY	30.00	90.00								30.00	90.00		30.00	60.00									4
H3814	007	0	1	01	01	H3814_007_0	4	1	1	TIER ONE-GENERIC	001000		2	TIER ONE-GENERIC	011000000011011000000	30	90								30	90		30	90								TIER ONE-GENERIC	2	2		011000000011011000000	TIER ONE-GENERIC																						TIER ONE-GENERIC	6.00	18.00								6.00	18.00		6.00	12.00									2
H3814	007	0	1	01	01	H3814_007_0	4	2	1	TIER TWO-BRAND	000001		2	TIER TWO-BRAND	011000000011011000000	30	90								30	90		30	90								TIER TWO-BRAND	2	2		011000000011011000000	TIER TWO-BRAND																						TIER TWO-BRAND	25.00	75.00								25.00	75.00		25.00	50.00									2
H3814	007	0	1	01	01	H3814_007_0	4	3	1	TIER THREE-SPECIALTY	100100		1	TIER THREE-SPECIALTY	011000000011011000000	30	90								30	90		30	90								TIER THREE-SPECIALTY	2	2		011000000011011000000	TIER THREE-SPECIALTY																						TIER THREE-SPECIALTY	25.00	75.00								25.00	75.00		25.00	50.00									2
H3815	001	0	1	01	01	H3815_001_0	7	3	1	Formulary Non-Preferred Brand	100000	3	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								20				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	20.00	60.00								20.00				40.00									4
H3815	001	0	1	01	01	H3815_001_0	7	4	1	Formulary Specialty	010010	3	1	Formulary Specialty	011000000010000000000	30	90								20												Formulary Specialty	2	1	011000000010000000000		Formulary Specialty	20	20								20												Formulary Specialty																							4
H3815	001	0	1	01	01	H3815_001_0	7	2	1	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand	011000000010001000000	30	90								20				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	15.00	45.00								15.00				30.00									4
H3815	001	0	1	01	01	H3815_001_0	7	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								20				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	3.00	9.00								3.00				6.00									4
H3817	002	0	1	04	01	H3817_002_0	4	4	1	Specialty	110001		1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							2
H3817	002	0	1	04	01	H3817_002_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	105.00		35.00			35.00			105.00	105.00									2
H3817	002	0	1	04	01	H3817_002_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				18.00	54.00		18.00			18.00			54.00	54.00									2
H3817	002	0	1	04	01	H3817_002_0	4	5	1	Miscellaneous Injectable	110001		2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							2
H3817	002	0	1	04	01	H3817_002_0	4	1	1	Generic	010000		2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									2
H3817	003	0	1	04	01	H3817_003_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3817	003	0	1	04	01	H3817_003_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3817	003	0	1	04	01	H3817_003_0	4	4	3	Specialty Medications	110001	1	1	Specialty Medications																							Specialty Medications					Specialty Medications																						Specialty Medications																						2	4
H3817	003	0	1	04	01	H3817_003_0	4	5	3	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables																							Miscellaneous Injectables					Miscellaneous Injectables																						Miscellaneous Injectables																						2	4
H3817	003	0	1	04	01	H3817_003_0	4	1	3	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00								1	4
H3817	003	0	1	04	01	H3817_003_0	4	5	1	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables	000010010010010000000				30			30			30			30									Miscellaneous Injectables	2	1	000010010010010000000		Miscellaneous Injectables				25			25			25			25									Miscellaneous Injectables																							4
H3817	003	0	1	04	01	H3817_003_0	4	4	1	Specialty Medications	110001	1	1	Specialty Medications	000010010010010000000				30			30			30			30									Specialty Medications	2	1	000010010010010000000		Specialty Medications				25			25			25			25									Specialty Medications																							4
H3817	003	0	1	04	01	H3817_003_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	150.00		50.00			50.00			150.00	150.00									4
H3817	003	0	1	04	01	H3817_003_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00			25.00			75.00	75.00									4
H3817	003	0	1	04	01	H3817_003_0	4	1	1	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									4
H3818	001	0	1	01	01	H3818_001_0	7	3	1	Brand Name	000001		2	Brand Name	011000000000111000000	31	90										10	31	90								Brand Name	2	2		011000000000111000000	Brand Name																						Brand Name	31.00	93.00										31.00	31.00	93.00									3
H3818	001	0	1	01	01	H3818_001_0	7	2	1	Generic	001000		2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	7.00	21.00										7.00	7.00	21.00									3
H3818	001	0	1	01	01	H3818_001_0	7	1	1	OTC	010010		2	OTC	011000000000111000000	31	90										10	31	90								OTC	2	4	011000000000111000000	011000000000111000000	OTC	0	0										0	0	0								OTC	0.00	0.00										0.00	0.00	0.00									3
H3818	001	0	1	01	01	H3818_001_0	7	5	1	Vaccines	001001		2	Vaccines	010000000000110000000	31											10	31									Vaccines	2	1	010000000000110000000		Vaccines	50											50	50									Vaccines																							3
H3818	001	0	1	01	01	H3818_001_0	7	4	1	Speciality	001001		1	Speciality	010000000000110000000	31											10	31									Speciality	2	1	010000000000110000000		Speciality	25											25	25									Speciality																							3
H3856	014	0	2	01	01	H3856_014_0	3	4	1	Specialty	110001		1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							2
H3856	014	0	2	01	01	H3856_014_0	3	1	1	Generic	010000		2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									2
H3856	014	0	2	01	01	H3856_014_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				18.00	54.00		18.00			18.00			54.00	54.00									2
H3856	014	0	2	01	01	H3856_014_0	3	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	105.00		35.00			35.00			105.00	105.00									2
H3856	014	0	2	01	01	H3856_014_0	3	5	1	Miscellaneous Injectable	110001		2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							2
H3856	016	0	1	01	01	H3856_016_0	2	5	1	Miscellaneous Injectable	110001		2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							2
H3856	016	0	1	01	01	H3856_016_0	2	4	1	Specialty	110001		1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							2
H3856	016	0	1	01	01	H3856_016_0	2	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	105.00		35.00			35.00			105.00	105.00									2
H3856	016	0	1	01	01	H3856_016_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				18.00	54.00		18.00			18.00			54.00	54.00									2
H3856	016	0	1	01	01	H3856_016_0	2	1	1	Generic	010000		2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									2
H3864	006	0	1	01	01	H3864_006_0	7	3	1	Specialty Medications	010010		1	Specialty Medications	010000000010000000000	31									31												Specialty Medications	2	2		010000000010000000000	Specialty Medications																						Specialty Medications	100.00									100.00													3
H3864	006	0	1	01	01	H3864_006_0	7	2	1	Formulary Brand	000001		2	Formulary Brand	011000000010001000000	31	93								31				93								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	29.50	60.00								29.50				60.00									3
H3864	006	0	1	01	01	H3864_006_0	7	1	1	Formulary Generic	001000		2	Formulary Generic	011000000010001000000	31	93								31				93								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	20.00								10.00				20.00									3
H3864	007	0	1	02	01	H3864_007_0	7	3	1	Specialty Medications	010010		1	Specialty Medications	010000000010000000000	31									31												Specialty Medications	2	2		010000000010000000000	Specialty Medications																						Specialty Medications	100.00									100.00													3
H3864	007	0	1	02	01	H3864_007_0	7	2	1	Formulary Brand	000001		2	Formulary Brand	011000000010001000000	31	93								31				93								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	29.50	60.00								29.50				60.00									3
H3864	007	0	1	02	01	H3864_007_0	7	1	1	Formulary Generic	001000		2	Formulary Generic	011000000010001000000	31	93								31				93								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	20.00								10.00				20.00									3
H3887	001	0	1	02	01	H3887_001_0	5	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H3887	001	0	1	02	01	H3887_001_0	5	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H3887	001	0	1	02	01	H3887_001_0	5	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H3887	001	0	1	02	01	H3887_001_0	5	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H3887	002	0	1	02	01	H3887_002_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3887	002	0	1	02	01	H3887_002_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3887	002	0	1	02	01	H3887_002_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H3887	002	0	1	02	01	H3887_002_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3887	003	0	1	02	01	H3887_003_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3887	003	0	1	02	01	H3887_003_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3887	003	0	1	02	01	H3887_003_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3887	003	0	1	02	01	H3887_003_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3907	006	0	1	01	01	H3907_006_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									4
H3907	006	0	1	01	01	H3907_006_0	3	4	3	Low Cost Injectables	010010	1	2	Low Cost Injectables																							Low Cost Injectables					Low Cost Injectables																						Low Cost Injectables																						2	4
H3907	006	0	1	01	01	H3907_006_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00				150.00									4
H3907	006	0	1	01	01	H3907_006_0	3	4	1	Low Cost Injectables	010010	1	2	Low Cost Injectables	011000000010001000000	31	90								31				90								Low Cost Injectables	2	1	011000000010001000000		Low Cost Injectables	25	25								25				25								Low Cost Injectables																							4
H3907	006	0	1	01	01	H3907_006_0	3	5	1	Specialty	010010	1	1	Specialty	010000000010010000000	31									31			31									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H3907	006	0	1	01	01	H3907_006_0	3	1	3	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00								1	4
H3907	006	0	1	01	01	H3907_006_0	3	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H3907	006	0	1	01	01	H3907_006_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
H3907	006	0	1	01	01	H3907_006_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3907	006	0	1	01	01	H3907_006_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3907	020	0	1	01	01	H3907_020_0	4	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									3
H3907	020	0	1	01	01	H3907_020_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				105.00									3
H3907	020	0	1	01	01	H3907_020_0	4	3	1	Brand	000010		2	Brand	011000000010001000000	31	90								31				90								Brand	2	2		011000000010001000000	Brand																						Brand	70.00	210.00								70.00				210.00									3
H3907	020	0	1	01	01	H3907_020_0	4	4	1	Low Cost Injectables	010010		2	Low Cost Injectables	011000000010001000000	31	90								31				90								Low Cost Injectables	2	1	011000000010001000000		Low Cost Injectables	25	25								25				25								Low Cost Injectables																							3
H3907	020	0	1	01	01	H3907_020_0	4	5	1	Specialty	010010		1	Specialty	010000000010010000000	31									31			31									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
H3907	021	0	1	01	01	H3907_021_0	4	5	1	Specialty	010010		1	Specialty	010000000010010000000	31									31			31									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
H3907	021	0	1	01	01	H3907_021_0	4	4	1	Low Cost Injectables	010010		2	Low Cost Injectables	011000000010001000000	31	90								31				90								Low Cost Injectables	2	1	011000000010001000000		Low Cost Injectables	25	25								25				25								Low Cost Injectables																							3
H3907	021	0	1	01	01	H3907_021_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	64.00	192.00								64.00				192.00									3
H3907	021	0	1	01	01	H3907_021_0	4	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									3
H3907	021	0	1	01	01	H3907_021_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00				96.00									3
H3909	001	0	1	04	01	H3909_001_0	6	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
H3909	001	0	1	04	01	H3909_001_0	6	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 2 - Preferred Brand	2	2		011000000011011000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									3
H3909	001	0	1	04	01	H3909_001_0	6	3	1	Tier 3 - Non-Preferred Brand	100000		2	Tier 3 - Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 3 - Non-Preferred Brand	2	2		011000000011011000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	150.00								50.00	150.00		50.00	100.00									3
H3912	001	0	1	04	01	H3912_001_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H3912	001	0	1	04	01	H3912_001_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H3912	001	0	1	04	01	H3912_001_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H3912	001	0	1	04	01	H3912_001_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H3912	004	0	1	04	01	H3912_004_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H3912	004	0	1	04	01	H3912_004_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H3912	004	0	1	04	01	H3912_004_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H3912	004	0	1	04	01	H3912_004_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H3912	005	0	1	04	01	H3912_005_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3912	005	0	1	04	01	H3912_005_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3912	005	0	1	04	01	H3912_005_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H3912	005	0	1	04	01	H3912_005_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3912	006	0	1	04	01	H3912_006_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3912	006	0	1	04	01	H3912_006_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H3912	006	0	1	04	01	H3912_006_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H3912	006	0	1	04	01	H3912_006_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H3916	001	0	1	04	01	H3916_001_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3916	001	0	1	04	01	H3916_001_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3916	002	0	1	04	01	H3916_002_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3916	002	0	1	04	01	H3916_002_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3916	003	0	1	04	01	H3916_003_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3916	003	0	1	04	01	H3916_003_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3916	005	0	1	04	01	H3916_005_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3916	005	0	1	04	01	H3916_005_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3916	005	0	1	04	01	H3916_005_0	5	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00	24.00		20.00	20.00								1	4
H3916	005	0	1	04	01	H3916_005_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	34	90								34	90		34	90								Non-Preferred Brand	1	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00	150.00		125.00	125.00									4
H3916	005	0	1	04	01	H3916_005_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00		50.00	50.00									4
H3916	005	0	1	04	01	H3916_005_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00	24.00		20.00	20.00									4
H3916	015	0	1	04	01	H3916_015_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3916	015	0	1	04	01	H3916_015_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3916	018	0	1	04	01	H3916_018_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3916	018	0	1	04	01	H3916_018_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3916	019	0	1	04	01	H3916_019_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3916	019	0	1	04	01	H3916_019_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3916	020	0	1	04	01	H3916_020_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3916	020	0	1	04	01	H3916_020_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3916	021	0	1	04	01	H3916_021_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3916	021	0	1	04	01	H3916_021_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3920	001	0	1	01	01	H3920_001_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
H3920	001	0	1	01	01	H3920_001_0	5	3	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H3920	001	0	1	01	01	H3920_001_0	5	4	1	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Brand	2	2		011000000010001000000	Non-Preferred Generic/Brand																						Non-Preferred Generic/Brand	45.00	135.00								45.00				135.00									4
H3920	001	0	1	01	01	H3920_001_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				12.00									4
H3920	002	0	1	01	01	H3920_002_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				12.00									4
H3920	002	0	1	01	01	H3920_002_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
H3920	002	0	1	01	01	H3920_002_0	4	3	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H3920	002	0	1	01	01	H3920_002_0	4	4	3	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand																							Non-Preferred Generic/Brand					Non-Preferred Generic/Brand																						Non-Preferred Generic/Brand																						2	4
H3920	002	0	1	01	01	H3920_002_0	4	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				12.00								1	4
H3920	002	0	1	01	01	H3920_002_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3920	002	0	1	01	01	H3920_002_0	4	3	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H3920	002	0	1	01	01	H3920_002_0	4	4	1	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Brand	2	2		011000000010001000000	Non-Preferred Generic/Brand																						Non-Preferred Generic/Brand	45.00	135.00								45.00				135.00									4
H3921	001	0	1	04	01	H3921_001_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3921	001	0	1	04	01	H3921_001_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3921	001	0	1	04	01	H3921_001_0	8	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3921	001	0	1	04	01	H3921_001_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3921	003	0	1	04	01	H3921_003_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H3921	003	0	1	04	01	H3921_003_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H3921	003	0	1	04	01	H3921_003_0	9	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H3921	003	0	1	04	01	H3921_003_0	9	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H3923	001	0	1	04	01	H3923_001_0	6	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	001	0	1	04	01	H3923_001_0	6	2	1	Tier 2 - Formulary Brand	000001	3	2	Tier 2 - Formulary Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Formulary Brand	1	2		011000000011001000000	Tier 2 - Formulary Brand																						Tier 2 - Formulary Brand	30.00	75.00								30.00	75.00			75.00									4
H3923	001	0	1	04	01	H3923_001_0	6	3	1	Tier 3 - High Cost Injectable	000010	1	1	Tier 3 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 3 - High Cost Injectable	2	4	011000000011001000000	011000000011001000000	Tier 3 - High Cost Injectable	25	25								25	25			25								Tier 3 - High Cost Injectable	100.00	250.00								100.00	250.00			250.00									4
H3923	002	0	1	04	01	H3923_002_0	6	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	002	0	1	04	01	H3923_002_0	6	2	1	Tier 2 - Formulary Brand	000001	3	2	Tier 2 - Formulary Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Formulary Brand	1	2		011000000011001000000	Tier 2 - Formulary Brand																						Tier 2 - Formulary Brand	30.00	75.00								30.00	75.00			75.00									4
H3923	002	0	1	04	01	H3923_002_0	6	3	1	Tier 3 - High Cost Injectable	000010	1	1	Tier 3 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 3 - High Cost Injectable	2	4	011000000011001000000	011000000011001000000	Tier 3 - High Cost Injectable	25	25								25	25			25								Tier 3 - High Cost Injectable	100.00	250.00								100.00	250.00			250.00									4
H3923	003	0	1	04	01	H3923_003_0	6	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	003	0	1	04	01	H3923_003_0	6	2	1	Tier 2 - Formulary Brand	000001	3	2	Tier 2 - Formulary Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Formulary Brand	1	2		011000000011001000000	Tier 2 - Formulary Brand																						Tier 2 - Formulary Brand	30.00	75.00								30.00	75.00			75.00									4
H3923	003	0	1	04	01	H3923_003_0	6	3	1	Tier 3 - High Cost Injectable	000010	1	1	Tier 3 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 3 - High Cost Injectable	2	4	011000000011001000000	011000000011001000000	Tier 3 - High Cost Injectable	25	25								25	25			25								Tier 3 - High Cost Injectable	100.00	250.00								100.00	250.00			250.00									4
H3923	004	0	1	04	01	H3923_004_0	6	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	004	0	1	04	01	H3923_004_0	6	2	1	Tier 2 - Formulary Brand	000001	3	2	Tier 2 - Formulary Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Formulary Brand	1	2		011000000011001000000	Tier 2 - Formulary Brand																						Tier 2 - Formulary Brand	30.00	75.00								30.00	75.00			75.00									4
H3923	004	0	1	04	01	H3923_004_0	6	3	1	Tier 3 - High Cost Injectable	000010	1	1	Tier 3 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 3 - High Cost Injectable	2	4	011000000011001000000	011000000011001000000	Tier 3 - High Cost Injectable	25	25								25	25			25								Tier 3 - High Cost Injectable	100.00	250.00								100.00	250.00			250.00									4
H3923	013	0	1	04	01	H3923_013_0	9	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3923	013	0	1	04	01	H3923_013_0	9	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3923	013	0	1	04	01	H3923_013_0	9	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3923	013	0	1	04	01	H3923_013_0	9	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3923	013	0	1	04	01	H3923_013_0	9	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	013	0	1	04	01	H3923_013_0	9	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3923	013	0	1	04	01	H3923_013_0	9	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3923	013	0	1	04	01	H3923_013_0	9	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3923	014	0	1	04	01	H3923_014_0	9	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	014	0	1	04	01	H3923_014_0	9	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3923	014	0	1	04	01	H3923_014_0	9	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3923	014	0	1	04	01	H3923_014_0	9	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3923	014	0	1	04	01	H3923_014_0	9	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3923	014	0	1	04	01	H3923_014_0	9	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3923	014	0	1	04	01	H3923_014_0	9	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3923	014	0	1	04	01	H3923_014_0	9	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3923	015	0	1	04	01	H3923_015_0	9	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	015	0	1	04	01	H3923_015_0	9	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3923	015	0	1	04	01	H3923_015_0	9	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3923	015	0	1	04	01	H3923_015_0	9	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3923	015	0	1	04	01	H3923_015_0	9	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3923	015	0	1	04	01	H3923_015_0	9	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3923	015	0	1	04	01	H3923_015_0	9	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3923	015	0	1	04	01	H3923_015_0	9	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3923	016	0	1	04	01	H3923_016_0	9	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	016	0	1	04	01	H3923_016_0	9	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3923	016	0	1	04	01	H3923_016_0	9	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3923	016	0	1	04	01	H3923_016_0	9	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3923	016	0	1	04	01	H3923_016_0	9	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3923	016	0	1	04	01	H3923_016_0	9	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3923	016	0	1	04	01	H3923_016_0	9	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3923	016	0	1	04	01	H3923_016_0	9	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3923	017	0	1	04	01	H3923_017_0	8	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3923	017	0	1	04	01	H3923_017_0	8	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3923	017	0	1	04	01	H3923_017_0	8	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3923	017	0	1	04	01	H3923_017_0	8	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3923	017	0	1	04	01	H3923_017_0	8	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3923	017	0	1	04	01	H3923_017_0	8	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3923	017	0	1	04	01	H3923_017_0	8	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	017	0	1	04	01	H3923_017_0	8	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3923	018	0	1	04	01	H3923_018_0	8	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3923	018	0	1	04	01	H3923_018_0	8	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3923	018	0	1	04	01	H3923_018_0	8	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3923	018	0	1	04	01	H3923_018_0	8	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3923	018	0	1	04	01	H3923_018_0	8	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3923	018	0	1	04	01	H3923_018_0	8	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3923	018	0	1	04	01	H3923_018_0	8	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	018	0	1	04	01	H3923_018_0	8	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3923	019	0	1	04	01	H3923_019_0	8	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	019	0	1	04	01	H3923_019_0	8	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3923	019	0	1	04	01	H3923_019_0	8	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3923	019	0	1	04	01	H3923_019_0	8	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3923	019	0	1	04	01	H3923_019_0	8	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3923	019	0	1	04	01	H3923_019_0	8	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3923	019	0	1	04	01	H3923_019_0	8	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3923	019	0	1	04	01	H3923_019_0	8	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3923	020	0	1	04	01	H3923_020_0	8	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3923	020	0	1	04	01	H3923_020_0	8	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3923	020	0	1	04	01	H3923_020_0	8	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3923	020	0	1	04	01	H3923_020_0	8	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3923	020	0	1	04	01	H3923_020_0	8	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3923	020	0	1	04	01	H3923_020_0	8	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3923	020	0	1	04	01	H3923_020_0	8	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3923	020	0	1	04	01	H3923_020_0	8	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3924	003	0	1	04	01	H3924_003_0	5	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3924	003	0	1	04	01	H3924_003_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3924	003	0	1	04	01	H3924_003_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3924	004	0	1	04	01	H3924_004_0	4	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3924	004	0	1	04	01	H3924_004_0	4	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3924	004	0	1	04	01	H3924_004_0	4	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3924	007	0	1	04	01	H3924_007_0	5	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3924	007	0	1	04	01	H3924_007_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3924	007	0	1	04	01	H3924_007_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3924	008	0	1	04	01	H3924_008_0	4	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3924	008	0	1	04	01	H3924_008_0	4	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3924	008	0	1	04	01	H3924_008_0	4	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3924	011	0	1	04	01	H3924_011_0	5	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3924	011	0	1	04	01	H3924_011_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3924	011	0	1	04	01	H3924_011_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3924	012	0	1	04	01	H3924_012_0	4	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3924	012	0	1	04	01	H3924_012_0	4	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3924	012	0	1	04	01	H3924_012_0	4	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3924	015	0	1	04	01	H3924_015_0	5	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3924	015	0	1	04	01	H3924_015_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3924	015	0	1	04	01	H3924_015_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3924	016	0	1	04	01	H3924_016_0	4	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3924	016	0	1	04	01	H3924_016_0	4	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3924	016	0	1	04	01	H3924_016_0	4	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3924	019	0	1	04	01	H3924_019_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3924	019	0	1	04	01	H3924_019_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3924	019	0	1	04	01	H3924_019_0	5	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3924	020	0	1	04	01	H3924_020_0	4	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3924	020	0	1	04	01	H3924_020_0	4	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3924	020	0	1	04	01	H3924_020_0	4	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3924	023	0	1	04	01	H3924_023_0	5	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3924	023	0	1	04	01	H3924_023_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3924	023	0	1	04	01	H3924_023_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3924	024	0	1	04	01	H3924_024_0	4	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3924	024	0	1	04	01	H3924_024_0	4	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3924	024	0	1	04	01	H3924_024_0	4	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3924	027	0	1	04	01	H3924_027_0	5	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3924	027	0	1	04	01	H3924_027_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3924	027	0	1	04	01	H3924_027_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3924	028	0	1	04	01	H3924_028_0	4	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3924	028	0	1	04	01	H3924_028_0	4	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3924	028	0	1	04	01	H3924_028_0	4	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3924	031	0	1	04	01	H3924_031_0	5	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3924	031	0	1	04	01	H3924_031_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3924	031	0	1	04	01	H3924_031_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3924	032	0	1	04	01	H3924_032_0	4	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3924	032	0	1	04	01	H3924_032_0	4	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3924	032	0	1	04	01	H3924_032_0	4	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3931	004	0	1	01	01	H3931_004_0	3	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3931	004	0	1	01	01	H3931_004_0	3	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H3931	004	0	1	01	01	H3931_004_0	3	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H3931	004	0	1	01	01	H3931_004_0	3	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3931	004	0	1	01	01	H3931_004_0	3	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H3931	004	0	1	01	01	H3931_004_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3931	004	0	1	01	01	H3931_004_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3931	004	0	1	01	01	H3931_004_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3931	058	0	1	01	01	H3931_058_0	3	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H3931	058	0	1	01	01	H3931_058_0	3	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3931	058	0	1	01	01	H3931_058_0	3	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H3931	058	0	1	01	01	H3931_058_0	3	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3931	058	0	1	01	01	H3931_058_0	3	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H3931	058	0	1	01	01	H3931_058_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3931	058	0	1	01	01	H3931_058_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3931	058	0	1	01	01	H3931_058_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3931	060	0	1	01	01	H3931_060_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H3931	060	0	1	01	01	H3931_060_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H3931	060	0	1	01	01	H3931_060_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3931	063	0	1	01	01	H3931_063_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H3931	063	0	1	01	01	H3931_063_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H3931	063	0	1	01	01	H3931_063_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3931	064	0	1	01	01	H3931_064_0	3	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H3931	064	0	1	01	01	H3931_064_0	3	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3931	064	0	1	01	01	H3931_064_0	3	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H3931	064	0	1	01	01	H3931_064_0	3	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3931	064	0	1	01	01	H3931_064_0	3	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H3931	064	0	1	01	01	H3931_064_0	3	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H3931	065	0	1	01	01	H3931_065_0	3	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				39.00	97.50		39.00	117.00		78.00							78.00			117.00			3
H3931	065	0	1	01	01	H3931_065_0	3	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H3931	065	0	1	01	01	H3931_065_0	3	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3931	067	0	1	01	01	H3931_067_0	3	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H3931	067	0	1	01	01	H3931_067_0	3	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H3931	067	0	1	01	01	H3931_067_0	3	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H3931	068	0	1	01	01	H3931_068_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H3931	068	0	1	01	01	H3931_068_0	3	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H3931	068	0	1	01	01	H3931_068_0	3	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H3931	068	0	1	01	01	H3931_068_0	3	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H3931	068	0	1	01	01	H3931_068_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H3931	068	0	1	01	01	H3931_068_0	3	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H3931	068	0	1	01	01	H3931_068_0	3	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H3931	068	0	1	01	01	H3931_068_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H3949	002	0	1	01	01	H3949_002_0	7	1	1	Generic	010000		2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	10.00									3
H3949	002	0	1	01	01	H3949_002_0	7	4	1	Specialty	000010		1	Specialty	011000000010011000000	31	90								31			31	90								Specialty	2	1	011000000010011000000		Specialty	25	25								25			25	25								Specialty																							3
H3949	002	0	1	01	01	H3949_002_0	7	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000010011000000	31	90								31			31	90								Non-Preferred  Brand	2	2		011000000010011000000	Non-Preferred  Brand																						Non-Preferred  Brand	50.00	150.00								50.00			50.00	100.00									3
H3949	002	0	1	01	01	H3949_002_0	7	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	60.00									3
H3949	012	0	1	01	01	H3949_012_0	8	1	1	Generic	010000		2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	10.00									3
H3949	012	0	1	01	01	H3949_012_0	8	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00			29.00	58.00									3
H3949	012	0	1	01	01	H3949_012_0	8	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000010011000000	31	90								31			31	90								Non-Preferred  Brand	2	2		011000000010011000000	Non-Preferred  Brand																						Non-Preferred  Brand	58.00	174.00								58.00			58.00	116.00									3
H3949	012	0	1	01	01	H3949_012_0	8	4	1	Specialty	000010		1	Specialty	011000000010011000000	31	90								31			31	90								Specialty	2	1	011000000010011000000		Specialty	25	25								25			25	25								Specialty																							3
H3949	013	0	1	01	01	H3949_013_0	7	1	1	Generic	010000		2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	10.00									3
H3949	013	0	1	01	01	H3949_013_0	7	4	1	Specialty	000010		1	Specialty	011000000010011000000	31	90								31			31	90								Specialty	2	1	011000000010011000000		Specialty	25	25								25			25	25								Specialty																							3
H3949	013	0	1	01	01	H3949_013_0	7	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000010011000000	31	90								31			31	90								Non-Preferred  Brand	2	2		011000000010011000000	Non-Preferred  Brand																						Non-Preferred  Brand	54.00	162.00								54.00			54.00	108.00									3
H3949	013	0	1	01	01	H3949_013_0	7	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00			29.00	58.00									3
H3952	018	0	1	01	01	H3952_018_0	6	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	010000000010010000000	31									31			31									Tier 1 - Generic	2	2		010000000010010000000	Tier 1 - Generic																						Tier 1 - Generic	0.00									0.00			0.00										3
H3952	018	0	1	01	01	H3952_018_0	6	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	010000000010010000000	31									31			31									Tier 2 - Preferred Brand	2	2		010000000010010000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	40.00									40.00			40.00										3
H3952	018	0	1	01	01	H3952_018_0	6	3	1	Tier 3 - Non-Preferred Brand	100000		2	Tier 3 - Non-Preferred Brand	010000000010010000000	31									31			31									Tier 3 - Non-Preferred Brand	2	2		010000000010010000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	75.00									75.00			75.00										3
H3952	018	0	1	01	01	H3952_018_0	6	4	1	Tier 4 - Specialty	110001		1	Tier 4 - Specialty	010000000010010000000	31									31			31									Tier 4 - Specialty	2	1	010000000010010000000		Tier 4 - Specialty	25									25			25									Tier 4 - Specialty																							3
H3952	020	0	1	01	01	H3952_020_0	6	3	1	Tier 3 - Non-Preferred Brand	100000		2	Tier 3 - Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 3 - Non-Preferred Brand	2	2		011000000011011000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	150.00								50.00	150.00		50.00	100.00									3
H3952	020	0	1	01	01	H3952_020_0	6	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
H3952	020	0	1	01	01	H3952_020_0	6	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 2 - Preferred Brand	2	2		011000000011011000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									3
H3952	032	0	1	02	01	H3952_032_0	8	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 2 - Preferred Brand	2	2		011000000011011000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									3
H3952	032	0	1	02	01	H3952_032_0	8	3	1	Tier 3 - Non-Preferred Brand	100000		2	Tier 3 - Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 3 - Non-Preferred Brand	2	2		011000000011011000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	150.00								50.00	150.00		50.00	100.00									3
H3952	032	0	1	02	01	H3952_032_0	8	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
H3954	021	0	1	01	01	H3954_021_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	021	0	1	01	01	H3954_021_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	021	0	1	01	01	H3954_021_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	022	0	1	01	01	H3954_022_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	022	0	1	01	01	H3954_022_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	022	0	1	01	01	H3954_022_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	024	0	1	01	01	H3954_024_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	024	0	1	01	01	H3954_024_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	024	0	1	01	01	H3954_024_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	025	0	1	01	01	H3954_025_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	025	0	1	01	01	H3954_025_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	025	0	1	01	01	H3954_025_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	027	0	1	01	01	H3954_027_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	027	0	1	01	01	H3954_027_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	027	0	1	01	01	H3954_027_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	028	0	1	01	01	H3954_028_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	028	0	1	01	01	H3954_028_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	028	0	1	01	01	H3954_028_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	030	0	1	01	01	H3954_030_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	030	0	1	01	01	H3954_030_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	030	0	1	01	01	H3954_030_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	031	0	1	01	01	H3954_031_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	031	0	1	01	01	H3954_031_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	031	0	1	01	01	H3954_031_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	033	0	1	01	01	H3954_033_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	033	0	1	01	01	H3954_033_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	033	0	1	01	01	H3954_033_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	034	0	1	01	01	H3954_034_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	034	0	1	01	01	H3954_034_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	034	0	1	01	01	H3954_034_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	036	0	1	01	01	H3954_036_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	036	0	1	01	01	H3954_036_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	036	0	1	01	01	H3954_036_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	037	0	1	01	01	H3954_037_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	037	0	1	01	01	H3954_037_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	037	0	1	01	01	H3954_037_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	039	0	1	01	01	H3954_039_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	039	0	1	01	01	H3954_039_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	039	0	1	01	01	H3954_039_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	040	0	1	01	01	H3954_040_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	040	0	1	01	01	H3954_040_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	040	0	1	01	01	H3954_040_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	042	0	1	01	01	H3954_042_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	042	0	1	01	01	H3954_042_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	042	0	1	01	01	H3954_042_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	043	0	1	01	01	H3954_043_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	043	0	1	01	01	H3954_043_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	043	0	1	01	01	H3954_043_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	045	0	1	01	01	H3954_045_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	045	0	1	01	01	H3954_045_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	045	0	1	01	01	H3954_045_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	046	0	1	01	01	H3954_046_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	046	0	1	01	01	H3954_046_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	046	0	1	01	01	H3954_046_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	048	0	1	01	01	H3954_048_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	048	0	1	01	01	H3954_048_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	048	0	1	01	01	H3954_048_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	049	0	1	01	01	H3954_049_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	049	0	1	01	01	H3954_049_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	049	0	1	01	01	H3954_049_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	051	0	1	01	01	H3954_051_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	051	0	1	01	01	H3954_051_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	051	0	1	01	01	H3954_051_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	052	0	1	01	01	H3954_052_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	052	0	1	01	01	H3954_052_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	052	0	1	01	01	H3954_052_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	054	0	1	01	01	H3954_054_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	054	0	1	01	01	H3954_054_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	054	0	1	01	01	H3954_054_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	055	0	1	01	01	H3954_055_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	055	0	1	01	01	H3954_055_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	055	0	1	01	01	H3954_055_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	057	0	1	01	01	H3954_057_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	057	0	1	01	01	H3954_057_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	057	0	1	01	01	H3954_057_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	058	0	1	01	01	H3954_058_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	058	0	1	01	01	H3954_058_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	058	0	1	01	01	H3954_058_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	060	0	1	01	01	H3954_060_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	060	0	1	01	01	H3954_060_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	060	0	1	01	01	H3954_060_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	061	0	1	01	01	H3954_061_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	061	0	1	01	01	H3954_061_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	061	0	1	01	01	H3954_061_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	063	0	1	01	01	H3954_063_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	063	0	1	01	01	H3954_063_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	063	0	1	01	01	H3954_063_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	064	0	1	01	01	H3954_064_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	064	0	1	01	01	H3954_064_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	064	0	1	01	01	H3954_064_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	067	0	1	01	01	H3954_067_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	067	0	1	01	01	H3954_067_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	067	0	1	01	01	H3954_067_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	068	0	1	01	01	H3954_068_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	068	0	1	01	01	H3954_068_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	068	0	1	01	01	H3954_068_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	075	0	1	01	01	H3954_075_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	075	0	1	01	01	H3954_075_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	075	0	1	01	01	H3954_075_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	076	0	1	01	01	H3954_076_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	076	0	1	01	01	H3954_076_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	076	0	1	01	01	H3954_076_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	079	0	1	01	01	H3954_079_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	079	0	1	01	01	H3954_079_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	079	0	1	01	01	H3954_079_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	080	0	1	01	01	H3954_080_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	080	0	1	01	01	H3954_080_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	080	0	1	01	01	H3954_080_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	091	0	1	01	01	H3954_091_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	091	0	1	01	01	H3954_091_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	091	0	1	01	01	H3954_091_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	092	0	1	01	01	H3954_092_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	092	0	1	01	01	H3954_092_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	092	0	1	01	01	H3954_092_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	097	0	1	01	01	H3954_097_0	7	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	1	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	0.00	0.00								0.00				0.00									3
H3954	097	0	1	01	01	H3954_097_0	7	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	097	0	1	01	01	H3954_097_0	7	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	84.00	252.00								84.00				210.00									3
H3954	100	0	1	01	01	H3954_100_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	100	0	1	01	01	H3954_100_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	100	0	1	01	01	H3954_100_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	101	0	1	01	01	H3954_101_0	6	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	101	0	1	01	01	H3954_101_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	101	0	1	01	01	H3954_101_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3954	104	0	1	01	01	H3954_104_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H3954	104	0	1	01	01	H3954_104_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H3954	104	0	1	01	01	H3954_104_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H3954	105	0	1	01	01	H3954_105_0	6	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H3954	105	0	1	01	01	H3954_105_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H3954	105	0	1	01	01	H3954_105_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H3957	003	0	1	01	01	H3957_003_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3957	003	0	1	01	01	H3957_003_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3957	006	0	1	01	01	H3957_006_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3957	006	0	1	01	01	H3957_006_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3957	016	0	1	01	01	H3957_016_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		25.00	25.00									3
H3957	016	0	1	01	01	H3957_016_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	31.00	93.00								31.00	93.00		77.50	77.50									3
H3957	020	0	1	01	01	H3957_020_0	3	1	1	Generic	010000	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		20.00	20.00									4
H3957	020	0	1	01	01	H3957_020_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00	75.00		62.50	62.50									4
H3957	020	0	1	01	01	H3957_020_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	34	90								34	90		34	90								Non-Preferred Brand	1	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00		150.00	150.00									4
H3957	020	0	1	01	01	H3957_020_0	3	1	3	Generic	010000	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		20.00	20.00								1	4
H3957	020	0	1	01	01	H3957_020_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3957	020	0	1	01	01	H3957_020_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3957	021	0	1	01	01	H3957_021_0	3	1	1	Generic	010000	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		20.00	20.00									4
H3957	021	0	1	01	01	H3957_021_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00	75.00		62.50	62.50									4
H3957	021	0	1	01	01	H3957_021_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3957	021	0	1	01	01	H3957_021_0	3	1	3	Generic	010000	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		20.00	20.00								1	4
H3957	021	0	1	01	01	H3957_021_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3957	021	0	1	01	01	H3957_021_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	34	90								34	90		34	90								Non-Preferred Brand	1	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00		150.00	150.00									4
H3957	022	0	1	01	01	H3957_022_0	3	1	1	Generic	010000	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		20.00	20.00									4
H3957	022	0	1	01	01	H3957_022_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00	75.00		62.50	62.50									4
H3957	022	0	1	01	01	H3957_022_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	34	90								34	90		34	90								Non-Preferred Brand	1	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00		150.00	150.00									4
H3957	022	0	1	01	01	H3957_022_0	3	1	3	Generic	010000	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	8.00	24.00								8.00	24.00		20.00	20.00								1	4
H3957	022	0	1	01	01	H3957_022_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3957	022	0	1	01	01	H3957_022_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H3959	001	0	1	01	01	H3959_001_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
H3959	001	0	1	01	01	H3959_001_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H3959	001	0	1	01	01	H3959_001_0	3	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00								1	4
H3959	001	0	1	01	01	H3959_001_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H3959	001	0	1	01	01	H3959_001_0	3	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00									4
H3959	001	0	1	01	01	H3959_001_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3959	001	0	1	01	01	H3959_001_0	3	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H3959	001	0	1	01	01	H3959_001_0	3	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3959	002	0	1	01	01	H3959_002_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
H3959	002	0	1	01	01	H3959_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H3959	002	0	1	01	01	H3959_002_0	3	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00									4
H3959	002	0	1	01	01	H3959_002_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H3959	002	0	1	01	01	H3959_002_0	3	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3959	002	0	1	01	01	H3959_002_0	3	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H3959	002	0	1	01	01	H3959_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3959	002	0	1	01	01	H3959_002_0	3	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00								1	4
H3959	006	0	1	01	01	H3959_006_0	3	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H3959	006	0	1	01	01	H3959_006_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H3959	006	0	1	01	01	H3959_006_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00				140.00									4
H3959	006	0	1	01	01	H3959_006_0	3	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H3959	006	0	1	01	01	H3959_006_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3959	006	0	1	01	01	H3959_006_0	3	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H3959	006	0	1	01	01	H3959_006_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H3959	006	0	1	01	01	H3959_006_0	3	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3959	008	0	1	01	01	H3959_008_0	3	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00								1	4
H3959	008	0	1	01	01	H3959_008_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H3959	008	0	1	01	01	H3959_008_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
H3959	008	0	1	01	01	H3959_008_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H3959	008	0	1	01	01	H3959_008_0	3	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00									4
H3959	008	0	1	01	01	H3959_008_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3959	008	0	1	01	01	H3959_008_0	3	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3959	008	0	1	01	01	H3959_008_0	3	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H3959	010	0	1	01	01	H3959_010_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H3959	010	0	1	01	01	H3959_010_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H3959	010	0	1	01	01	H3959_010_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									3
H3959	010	0	1	01	01	H3959_010_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
H3959	011	0	1	01	01	H3959_011_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H3959	011	0	1	01	01	H3959_011_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H3959	011	0	1	01	01	H3959_011_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
H3959	011	0	1	01	01	H3959_011_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									3
H3959	012	0	1	01	01	H3959_012_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H3959	012	0	1	01	01	H3959_012_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									3
H3959	012	0	1	01	01	H3959_012_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H3959	012	0	1	01	01	H3959_012_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
H3959	015	0	1	01	01	H3959_015_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H3959	015	0	1	01	01	H3959_015_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H3959	015	0	1	01	01	H3959_015_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
H3959	015	0	1	01	01	H3959_015_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									3
H3959	017	0	1	01	01	H3959_017_0	3	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H3959	017	0	1	01	01	H3959_017_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H3959	017	0	1	01	01	H3959_017_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00				140.00									4
H3959	017	0	1	01	01	H3959_017_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H3959	017	0	1	01	01	H3959_017_0	3	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H3959	017	0	1	01	01	H3959_017_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3959	017	0	1	01	01	H3959_017_0	3	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3959	017	0	1	01	01	H3959_017_0	3	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H3959	018	0	1	01	01	H3959_018_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H3959	018	0	1	01	01	H3959_018_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									3
H3959	018	0	1	01	01	H3959_018_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H3959	018	0	1	01	01	H3959_018_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
H3959	019	0	1	01	01	H3959_019_0	3	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00								1	4
H3959	019	0	1	01	01	H3959_019_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3959	019	0	1	01	01	H3959_019_0	3	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H3959	019	0	1	01	01	H3959_019_0	3	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3959	019	0	1	01	01	H3959_019_0	3	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00									4
H3959	019	0	1	01	01	H3959_019_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H3959	019	0	1	01	01	H3959_019_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
H3959	019	0	1	01	01	H3959_019_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H3959	020	0	1	01	01	H3959_020_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H3959	020	0	1	01	01	H3959_020_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H3959	020	0	1	01	01	H3959_020_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									3
H3959	020	0	1	01	01	H3959_020_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
H3959	021	0	1	01	01	H3959_021_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H3959	021	0	1	01	01	H3959_021_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H3959	021	0	1	01	01	H3959_021_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									3
H3959	021	0	1	01	01	H3959_021_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
H3959	022	0	1	01	01	H3959_022_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H3959	022	0	1	01	01	H3959_022_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H3959	022	0	1	01	01	H3959_022_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H3959	022	0	1	01	01	H3959_022_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H3959	022	0	1	01	01	H3959_022_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H3959	022	0	1	01	01	H3959_022_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00				140.00									4
H3959	022	0	1	01	01	H3959_022_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H3959	022	0	1	01	01	H3959_022_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H3959	023	0	1	01	01	H3959_023_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									3
H3959	023	0	1	01	01	H3959_023_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
H3959	023	0	1	01	01	H3959_023_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
H3959	023	0	1	01	01	H3959_023_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
H3962	001	0	1	01	01	H3962_001_0	8	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3962	001	0	1	01	01	H3962_001_0	8	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3962	001	0	1	01	01	H3962_001_0	8	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3962	001	0	1	01	01	H3962_001_0	8	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3962	001	0	1	01	01	H3962_001_0	8	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3962	001	0	1	01	01	H3962_001_0	8	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3962	001	0	1	01	01	H3962_001_0	8	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3962	001	0	1	01	01	H3962_001_0	8	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3962	002	0	1	01	01	H3962_002_0	7	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3962	002	0	1	01	01	H3962_002_0	7	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3962	002	0	1	01	01	H3962_002_0	7	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3962	002	0	1	01	01	H3962_002_0	7	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3962	002	0	1	01	01	H3962_002_0	7	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3962	002	0	1	01	01	H3962_002_0	7	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3962	002	0	1	01	01	H3962_002_0	7	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3962	002	0	1	01	01	H3962_002_0	7	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3962	003	0	1	01	01	H3962_003_0	7	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3962	003	0	1	01	01	H3962_003_0	7	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3962	003	0	1	01	01	H3962_003_0	7	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3962	003	0	1	01	01	H3962_003_0	7	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3962	003	0	1	01	01	H3962_003_0	7	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3962	003	0	1	01	01	H3962_003_0	7	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3962	003	0	1	01	01	H3962_003_0	7	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3962	003	0	1	01	01	H3962_003_0	7	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3962	004	0	1	01	01	H3962_004_0	8	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3962	004	0	1	01	01	H3962_004_0	8	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3962	004	0	1	01	01	H3962_004_0	8	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3962	004	0	1	01	01	H3962_004_0	8	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3962	004	0	1	01	01	H3962_004_0	8	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3962	004	0	1	01	01	H3962_004_0	8	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3962	004	0	1	01	01	H3962_004_0	8	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3962	004	0	1	01	01	H3962_004_0	8	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3962	005	0	1	01	01	H3962_005_0	8	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3962	005	0	1	01	01	H3962_005_0	8	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3962	005	0	1	01	01	H3962_005_0	8	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3962	005	0	1	01	01	H3962_005_0	8	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3962	005	0	1	01	01	H3962_005_0	8	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3962	005	0	1	01	01	H3962_005_0	8	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3962	005	0	1	01	01	H3962_005_0	8	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3962	005	0	1	01	01	H3962_005_0	8	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3962	006	0	1	01	01	H3962_006_0	8	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
H3962	006	0	1	01	01	H3962_006_0	8	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3962	006	0	1	01	01	H3962_006_0	8	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
H3962	006	0	1	01	01	H3962_006_0	8	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	25.00	65.00								25.00	65.00			65.00									4
H3962	006	0	1	01	01	H3962_006_0	8	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
H3962	006	0	1	01	01	H3962_006_0	8	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	50.00	125.00								50.00	125.00			125.00									4
H3962	006	0	1	01	01	H3962_006_0	8	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
H3962	006	0	1	01	01	H3962_006_0	8	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
H3962	007	0	1	01	01	H3962_007_0	8	2	1	Tier 2 - Formulary Brand	000001	3	2	Tier 2 - Formulary Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Formulary Brand	1	2		011000000011001000000	Tier 2 - Formulary Brand																						Tier 2 - Formulary Brand	30.00	75.00								30.00	75.00			75.00									4
H3962	007	0	1	01	01	H3962_007_0	8	3	1	Tier 3 - High Cost Injectable	000010	1	1	Tier 3 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 3 - High Cost Injectable	2	4	011000000011001000000	011000000011001000000	Tier 3 - High Cost Injectable	25	25								25	25			25								Tier 3 - High Cost Injectable	100.00	250.00								100.00	250.00			250.00									4
H3962	007	0	1	01	01	H3962_007_0	8	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3962	008	0	1	01	01	H3962_008_0	6	2	1	Tier 2 - Formulary Brand	000001	3	2	Tier 2 - Formulary Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Formulary Brand	1	2		011000000011001000000	Tier 2 - Formulary Brand																						Tier 2 - Formulary Brand	30.00	75.00								30.00	75.00			75.00									4
H3962	008	0	1	01	01	H3962_008_0	6	3	1	Tier 3 - High Cost Injectable	000010	1	1	Tier 3 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 3 - High Cost Injectable	2	4	011000000011001000000	011000000011001000000	Tier 3 - High Cost Injectable	25	25								25	25			25								Tier 3 - High Cost Injectable	100.00	250.00								100.00	250.00			250.00									4
H3962	008	0	1	01	01	H3962_008_0	6	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3962	009	0	1	01	01	H3962_009_0	6	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
H3962	009	0	1	01	01	H3962_009_0	6	3	1	Tier 3 - High Cost Injectable	000010	1	1	Tier 3 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 3 - High Cost Injectable	2	4	011000000011001000000	011000000011001000000	Tier 3 - High Cost Injectable	25	25								25	25			25								Tier 3 - High Cost Injectable	100.00	250.00								100.00	250.00			250.00									4
H3962	009	0	1	01	01	H3962_009_0	6	2	1	Tier 2 - Formulary Brand	000001	3	2	Tier 2 - Formulary Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Formulary Brand	1	2		011000000011001000000	Tier 2 - Formulary Brand																						Tier 2 - Formulary Brand	30.00	75.00								30.00	75.00			75.00									4
H3964	003	0	1	01	01	H3964_003_0	4	2	1	Formulary Brand	100001		2	Formulary Brand	000010010010000000000				30			30			30												Formulary Brand	2	2		000010010010000000000	Formulary Brand																						Formulary Brand				30.00			30.00			30.00													3
H3964	003	0	1	01	01	H3964_003_0	4	1	1	Formulary Generic	001100		2	Formulary Generic	000010010010000000000				30			30			30												Formulary Generic	2	2		000010010010000000000	Formulary Generic																						Formulary Generic				5.00			5.00			5.00													3
H3964	003	0	1	01	01	H3964_003_0	4	3	1	Formulary Specialty	101101		1	Formulary Specialty	000010010010000000000				30			30			30												Formulary Specialty	2	1	000010010010000000000		Formulary Specialty				25			25			25												Formulary Specialty																							3
H4003	001	0	1	02	01	H4003_001_0	5	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	2		011000000010001000000	Brand																						Brand	20.00	60.00								20.00				40.00									4
H4003	001	0	1	02	01	H4003_001_0	5	3	1	Specialty	010011	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							4
H4003	001	0	1	02	01	H4003_001_0	5	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				10.00									4
H4003	009	0	1	01	01	H4003_009_0	5	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	2		011000000010001000000	Brand																						Brand	20.00	60.00								20.00				40.00									4
H4003	009	0	1	01	01	H4003_009_0	5	3	1	Specialty	010011	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	2		011000000010001000000	Specialty																						Specialty	20.00	60.00								20.00				40.00									4
H4003	009	0	1	01	01	H4003_009_0	5	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				10.00									4
H4003	010	0	1	01	01	H4003_010_0	7	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	2		011000000010001000000	Brand																						Brand	3.00	9.00								3.00				6.00									4
H4003	010	0	1	01	01	H4003_010_0	7	3	1	Specialty	010011	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	2		011000000010001000000	Specialty																						Specialty	3.00	9.00								3.00				6.00									4
H4003	010	0	1	01	01	H4003_010_0	7	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	1.00	3.00								1.00				2.00									4
H4003	013	0	1	01	01	H4003_013_0	7	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	2		011000000010001000000	Brand																						Brand	9.00	27.00								9.00				18.00									4
H4003	013	0	1	01	01	H4003_013_0	7	3	1	Specialty	010011	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	2		011000000010001000000	Specialty																						Specialty	9.00	27.00								9.00				18.00									4
H4003	013	0	1	01	01	H4003_013_0	7	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	3.00	9.00								3.00				6.00									4
H4004	015	0	1	01	01	H4004_015_0	6	3	1	Formulary Brand	000010	1	2	Formulary Brand	011000000011000000000	30	90								30	90											Formulary Brand	2	2		011000000011000000000	Formulary Brand																						Formulary Brand	50.00	150.00								50.00	150.00												4
H4004	015	0	1	01	01	H4004_015_0	6	4	1	Preferred Brand	000001	1	1	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000011000000000	Preferred Brand																						Preferred Brand	50.00	150.00								50.00	150.00												4
H4004	015	0	1	01	01	H4004_015_0	6	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011000000000	30	90								30	90											Formulary Preferred Brand	2	2		011000000011000000000	Formulary Preferred Brand																						Formulary Preferred Brand	20.00	60.00								20.00	60.00												4
H4004	015	0	1	01	01	H4004_015_0	6	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011000000000	30	90								30	90											Formulary Generic	2	2		011000000011000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00	0.00												4
H4004	017	0	1	01	01	H4004_017_0	7	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011000000000	30	90								30	90											Formulary Preferred Brand	2	2		011000000011000000000	Formulary Preferred Brand																						Formulary Preferred Brand	15.00	45.00								15.00	45.00												4
H4004	017	0	1	01	01	H4004_017_0	7	3	1	Formulary Brand	000010	1	2	Formulary Brand	011000000011000000000	30	90								30	90											Formulary Brand	2	2		011000000011000000000	Formulary Brand																						Formulary Brand	40.00	120.00								40.00	120.00												4
H4004	017	0	1	01	01	H4004_017_0	7	4	1	Preferred Brand	000001	1	1	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000011000000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00												4
H4004	017	0	1	01	01	H4004_017_0	7	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011000000000	30	90								30	90											Formulary Generic	2	2		011000000011000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00	0.00												4
H4004	017	0	1	01	01	H4004_017_0	7	4	3	Preferred Brand	000001	1	1	Preferred Brand	011000000011000000000	30	90								30	90											Preferred Brand	2	2		011000000011000000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00											1	4
H4004	017	0	1	01	01	H4004_017_0	7	3	3	Formulary Brand	000010	1	2	Formulary Brand	011000000011000000000	30	90								30	90											Formulary Brand	2	2		011000000011000000000	Formulary Brand																						Formulary Brand	40.00	120.00								40.00	120.00											1	4
H4004	017	0	1	01	01	H4004_017_0	7	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011000000000	30	90								30	90											Formulary Preferred Brand	2	2		011000000011000000000	Formulary Preferred Brand																						Formulary Preferred Brand	15.00	45.00								15.00	45.00											1	4
H4004	017	0	1	01	01	H4004_017_0	7	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000011000000000	30	90								30	90											Formulary Generic	2	2		011000000011000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00	0.00											1	4
H4004	024	0	1	01	01	H4004_024_0	6	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011000000000	30	90								30	90											Formulary Generic	2	2		011000000011000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00	0.00												4
H4004	024	0	1	01	01	H4004_024_0	6	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011000000000	30	90								30	90											Formulary Preferred Brand	2	2		011000000011000000000	Formulary Preferred Brand																						Formulary Preferred Brand	20.00	60.00								20.00	60.00												4
H4004	024	0	1	01	01	H4004_024_0	6	4	1	Preferred Brand	000001	1	1	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000011000000000	Preferred Brand																						Preferred Brand	50.00	150.00								50.00	150.00												4
H4004	024	0	1	01	01	H4004_024_0	6	3	1	Formulary Brand	000010	1	2	Formulary Brand	011000000011000000000	30	90								30	90											Formulary Brand	2	2		011000000011000000000	Formulary Brand																						Formulary Brand	50.00	150.00								50.00	150.00												4
H4004	035	0	1	01	01	H4004_035_0	6	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011000000000	30	90								30	90											Formulary Preferred Brand	2	2		011000000011000000000	Formulary Preferred Brand																						Formulary Preferred Brand	20.00	60.00								20.00	60.00												4
H4004	035	0	1	01	01	H4004_035_0	6	3	1	Formulary Brand	000010	1	2	Formulary Brand	011000000011000000000	30	90								30	90											Formulary Brand	2	2		011000000011000000000	Formulary Brand																						Formulary Brand	50.00	150.00								50.00	150.00												4
H4004	035	0	1	01	01	H4004_035_0	6	4	1	Preferred Brand	000001	1	1	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000011000000000	Preferred Brand																						Preferred Brand	50.00	150.00								50.00	150.00												4
H4004	035	0	1	01	01	H4004_035_0	6	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011000000000	30	90								30	90											Formulary Generic	2	2		011000000011000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00	0.00												4
H4005	003	0	1	04	01	H4005_003_0	5	1	3	Generic	010000	1	2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	5.00	15.00	5.00							5.00	15.00	5.00		15.00								1	4
H4005	003	0	1	04	01	H4005_003_0	5	3	3	Brand	010010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H4005	003	0	1	04	01	H4005_003_0	5	4	3	Non Preferred Drugs	100100	1	2	Non Preferred Drugs																							Non Preferred Drugs					Non Preferred Drugs																						Non Preferred Drugs																						2	4
H4005	003	0	1	04	01	H4005_003_0	5	4	1	Non Preferred Drugs	100100	1	2	Non Preferred Drugs	011100000011101000000	30	90	15							30	90	15		90								Non Preferred Drugs	1	3	011100000011101000000	011100000011101000000	Non Preferred Drugs	25	25	25							25	25	25		25								Non Preferred Drugs	15.00	45.00	15.00							15.00	45.00	15.00		45.00									4
H4005	003	0	1	04	01	H4005_003_0	5	3	1	Brand	010010	1	2	Brand	011100000011101000000	30	90	15							30	90	15		90								Brand	1	2		011100000011101000000	Brand																						Brand	15.00	45.00	15.00							15.00	45.00	15.00		45.00									4
H4005	003	0	1	04	01	H4005_003_0	5	2	1	Preferred Brand	000011	1	2	Preferred Brand	011100000011101000000	30	90	15							30	90	15		90								Preferred Brand	2	2		011100000011101000000	Preferred Brand																						Preferred Brand	10.00	30.00	10.00							10.00	30.00	10.00		30.00									4
H4005	003	0	1	04	01	H4005_003_0	5	1	1	Generic	010000	1	2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	5.00	15.00	5.00							5.00	15.00	5.00		15.00									4
H4005	003	0	1	04	01	H4005_003_0	5	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4005	004	0	1	04	01	H4005_004_0	5	4	1	Non Preferred Drugs	100100		2	Non Preferred Drugs	011100000011101000000	30	90	15							30	90	15		90								Non Preferred Drugs	1	3	011100000011101000000	011100000011101000000	Non Preferred Drugs	25	25	25							25	25	25		25								Non Preferred Drugs	45.00	135.00	45.00							45.00	135.00	45.00		135.00									3
H4005	004	0	1	04	01	H4005_004_0	5	1	1	Generic	010000		2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	5.00	15.00	5.00							5.00	15.00	5.00		15.00									3
H4005	004	0	1	04	01	H4005_004_0	5	2	1	Preferred Brand	000011		2	Preferred Brand	011100000011101000000	30	90	15							30	90	15		90								Preferred Brand	2	2		011100000011101000000	Preferred Brand																						Preferred Brand	25.00	75.00	25.00							25.00	75.00	25.00		75.00									3
H4005	004	0	1	04	01	H4005_004_0	5	3	1	Brand	010010		2	Brand	011100000011101000000	30	90	15							30	90	15		90								Brand	1	2		011100000011101000000	Brand																						Brand	45.00	135.00	45.00							45.00	135.00	45.00		135.00									3
H4006	007	0	1	01	01	H4006_007_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	32.00	64.00								32.00	64.00			64.00									4
H4006	007	0	1	01	01	H4006_007_0	8	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							4
H4006	007	0	1	01	01	H4006_007_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	16.00	32.00								16.00	32.00			32.00									4
H4006	007	0	1	01	01	H4006_007_0	8	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	6.00	12.00								6.00	12.00			12.00									4
H4006	008	0	1	02	01	H4006_008_0	10	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	26.00	52.00								26.00	52.00			52.00									4
H4006	008	0	1	02	01	H4006_008_0	10	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	13.00	26.00								13.00	26.00			26.00									4
H4006	008	0	1	02	01	H4006_008_0	10	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									4
H4006	008	0	1	02	01	H4006_008_0	10	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							4
H4006	008	0	1	02	01	H4006_008_0	10	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00								1	4
H4006	008	0	1	02	01	H4006_008_0	10	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4006	008	0	1	02	01	H4006_008_0	10	4	3	Specialty Drugs	110001	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H4006	008	0	1	02	01	H4006_008_0	10	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4006	009	0	1	01	01	H4006_009_0	7	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							4
H4006	009	0	1	01	01	H4006_009_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00								50.00	100.00			100.00									4
H4006	009	0	1	01	01	H4006_009_0	7	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	5.00	10.00								5.00	10.00			10.00									4
H4006	009	0	1	01	01	H4006_009_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	20.00	40.00								20.00	40.00			40.00									4
H4006	013	0	1	01	01	H4006_013_0	7	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	7.00	14.00								7.00	14.00			14.00									4
H4006	013	0	1	01	01	H4006_013_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	35.00	70.00								35.00	70.00			70.00									4
H4006	013	0	1	01	01	H4006_013_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	140.00								70.00	140.00			140.00									4
H4006	013	0	1	01	01	H4006_013_0	7	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							4
H4006	014	0	1	01	01	H4006_014_0	6	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							4
H4006	014	0	1	01	01	H4006_014_0	6	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	7.00	14.00								7.00	14.00			14.00									4
H4006	014	0	1	01	01	H4006_014_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	35.00	70.00								35.00	70.00			70.00									4
H4006	014	0	1	01	01	H4006_014_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	140.00								70.00	140.00			140.00									4
H4006	015	0	1	01	01	H4006_015_0	5	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011011000000	30	90								30	90		30	90								Specialty Drugs	1	1	011000000011011000000		Specialty Drugs	25	25								25	25		25	25								Specialty Drugs																							4
H4006	015	0	1	01	01	H4006_015_0	5	1	1	Generic	010000	1	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	1	2		011000000011011000000	Generic																						Generic	7.00	14.00								7.00	14.00		7.00	14.00									4
H4006	015	0	1	01	01	H4006_015_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	35.00	70.00								35.00	70.00		35.00	70.00									4
H4006	015	0	1	01	01	H4006_015_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand	1	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	140.00								70.00	140.00		70.00	140.00									4
H4006	018	0	1	01	01	H4006_018_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	3.00	6.00								3.00	6.00			6.00									4
H4006	018	0	1	01	01	H4006_018_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	3.00	6.00								3.00	6.00			6.00									4
H4006	018	0	1	01	01	H4006_018_0	6	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	1.00	2.00								1.00	2.00			2.00									4
H4006	018	0	1	01	01	H4006_018_0	6	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							4
H4007	002	0	1	01	01	H4007_002_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4007	002	0	1	01	01	H4007_002_0	4	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
H4007	002	0	1	01	01	H4007_002_0	4	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4007	002	0	1	01	01	H4007_002_0	4	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H4007	002	0	1	01	01	H4007_002_0	4	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4007	002	0	1	01	01	H4007_002_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H4007	002	0	1	01	01	H4007_002_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00			15.00	37.50									4
H4007	002	0	1	01	01	H4007_002_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	35.00	105.00								35.00			35.00	87.50									4
H4007	005	0	1	01	01	H4007_005_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H4007	005	0	1	01	01	H4007_005_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00			15.00	37.50									4
H4007	005	0	1	01	01	H4007_005_0	4	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	35.00	105.00								35.00			35.00	87.50									4
H4007	005	0	1	01	01	H4007_005_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4008	001	0	1	09	04	H4008_001_0	8	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H4008	001	0	1	09	04	H4008_001_0	8	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00			15.00	37.50									4
H4008	001	0	1	09	04	H4008_001_0	8	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	35.00	105.00								35.00			35.00	87.50									4
H4008	001	0	1	09	04	H4008_001_0	8	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4009	002	0	1	01	01	H4009_002_0	8	1	3	Generic	010000	1	2	Generic	011000000010000000000	30	90								30												Generic	1	2		011000000010000000000	Generic																						Generic	3.00	9.00								3.00												1	4
H4009	002	0	1	01	01	H4009_002_0	8	2	3	Formulary preferred brand	000001	1	2	Formulary preferred brand																							Formulary preferred brand					Formulary preferred brand																						Formulary preferred brand																						2	4
H4009	002	0	1	01	01	H4009_002_0	8	3	3	Formulary Brand drugs	000010	1	2	Formulary Brand drugs																							Formulary Brand drugs					Formulary Brand drugs																						Formulary Brand drugs																						2	4
H4009	002	0	1	01	01	H4009_002_0	8	4	3	Specialty drug	000010	1	1	Specialty drug																							Specialty drug					Specialty drug																						Specialty drug																						2	4
H4009	002	0	1	01	01	H4009_002_0	8	3	1	Formulary Brand drugs	000010	1	2	Formulary Brand drugs	011000000010000000000	30	90								30												Formulary Brand drugs	1	2		011000000010000000000	Formulary Brand drugs																						Formulary Brand drugs	40.00	120.00								40.00													4
H4009	002	0	1	01	01	H4009_002_0	8	4	1	Specialty drug	000010	1	1	Specialty drug	011000000010000000000	30	90								30												Specialty drug	1	2		011000000010000000000	Specialty drug																						Specialty drug	40.00	120.00								40.00													4
H4009	002	0	1	01	01	H4009_002_0	8	1	1	Generic	010000	1	2	Generic	011000000010000000000	30	90								30												Generic	1	2		011000000010000000000	Generic																						Generic	3.00	9.00								3.00													4
H4009	002	0	1	01	01	H4009_002_0	8	2	1	Formulary preferred brand	000001	1	2	Formulary preferred brand	011000000010000000000	30	90								30												Formulary preferred brand	1	2		011000000010000000000	Formulary preferred brand																						Formulary preferred brand	25.00	75.00								25.00													4
H4009	003	0	1	01	01	H4009_003_0	15	4	1	Specialty drugs	000010		1	Specialty drugs	011000000010000000000	30	90								30												Specialty drugs	1	2		011000000010000000000	Specialty drugs																						Specialty drugs	45.00	135.00								45.00													3
H4009	003	0	1	01	01	H4009_003_0	15	3	1	Formulary brand	000010		2	Formulary brand	011000000010000000000	30	90								30												Formulary brand	2	2		011000000010000000000	Formulary brand																						Formulary brand	45.00	135.00								45.00													3
H4009	003	0	1	01	01	H4009_003_0	15	1	1	Generic	010000		2	Generic	011000000010000000000	30	90								30												Generic	1	2		011000000010000000000	Generic																						Generic	5.00	15.00								5.00													3
H4009	003	0	1	01	01	H4009_003_0	15	2	1	Preferred formulary brand	000001		2	Preferred formulary brand	011000000010000000000	30	90								30												Preferred formulary brand	2	2		011000000010000000000	Preferred formulary brand																						Preferred formulary brand	20.00	60.00								20.00													3
H4009	004	0	1	01	01	H4009_004_0	10	3	3	Formulary Brand drugs	000010	1	2	Formulary Brand drugs																							Formulary Brand drugs					Formulary Brand drugs																						Formulary Brand drugs																						2	4
H4009	004	0	1	01	01	H4009_004_0	10	2	3	Formulary preferred brand	000001	1	2	Formulary preferred brand																							Formulary preferred brand					Formulary preferred brand																						Formulary preferred brand																						2	4
H4009	004	0	1	01	01	H4009_004_0	10	1	3	Generic	010000	1	2	Generic	011000000010000000000	30	90								30												Generic	1	2		011000000010000000000	Generic																						Generic	0.00	0.00								0.00												1	4
H4009	004	0	1	01	01	H4009_004_0	10	4	1	Specialty drugs	000010	1	1	Specialty drugs	011000000010000000000	30	90								30												Specialty drugs	1	2		011000000010000000000	Specialty drugs																						Specialty drugs	10.00	30.00								10.00													4
H4009	004	0	1	01	01	H4009_004_0	10	3	1	Formulary Brand drugs	000010	1	2	Formulary Brand drugs	011000000010000000000	30	90								30												Formulary Brand drugs	1	2		011000000010000000000	Formulary Brand drugs																						Formulary Brand drugs	10.00	30.00								10.00													4
H4009	004	0	1	01	01	H4009_004_0	10	2	1	Formulary preferred brand	000001	1	2	Formulary preferred brand	011000000010000000000	30	90								30												Formulary preferred brand	1	2		011000000010000000000	Formulary preferred brand																						Formulary preferred brand	6.00	18.00								6.00													4
H4009	004	0	1	01	01	H4009_004_0	10	1	1	Generic	010000	1	2	Generic	011000000010000000000	30	90								30												Generic	1	2		011000000010000000000	Generic																						Generic	0.00	0.00								0.00													4
H4009	004	0	1	01	01	H4009_004_0	10	4	3	Specialty drugs	000010	1	1	Specialty drugs																							Specialty drugs					Specialty drugs																						Specialty drugs																						2	4
H4009	005	0	1	01	01	H4009_005_0	5	1	1	Generic	010000	1	1	Generic	011000000010000000000	30	90								30												Generic	1	2		011000000010000000000	Generic																						Generic	0.00	0.00								0.00													4
H4009	005	0	1	01	01	H4009_005_0	5	2	1	Formulary Preferred Brand	000001	1	1	Formulary Preferred Brand	011000000010000000000	30	90								30												Formulary Preferred Brand	1	2		011000000010000000000	Formulary Preferred Brand																						Formulary Preferred Brand	2.00	6.00								2.00													4
H4009	005	0	1	01	01	H4009_005_0	5	3	1	Formulary Brand	000010	1	1	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	1	2		011000000010000000000	Formulary Brand																						Formulary Brand	10.00	30.00								10.00													4
H4009	005	0	1	01	01	H4009_005_0	5	4	3	Specialty Drugs	000010	1	1	Specialty Drugs	011000000010000000000	30	90								30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	75	75								75												Specialty Drugs																						1	4
H4009	005	0	1	01	01	H4009_005_0	5	1	3	Generic	010000	1	1	Generic	011000000010000000000	30	90								30												Generic	1	2		011000000010000000000	Generic																						Generic	0.00	0.00								0.00												1	4
H4009	005	0	1	01	01	H4009_005_0	5	2	3	Formulary Preferred Brand	000001	1	1	Formulary Preferred Brand	011000000010000000000	30	90								30												Formulary Preferred Brand	1	1	011000000010000000000		Formulary Preferred Brand	75	75								75												Formulary Preferred Brand																						1	4
H4009	005	0	1	01	01	H4009_005_0	5	3	3	Formulary Brand	000010	1	1	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	1	1	011000000010000000000		Formulary Brand	75	75								75												Formulary Brand																						1	4
H4009	005	0	1	01	01	H4009_005_0	5	4	1	Specialty Drugs	000010	1	1	Specialty Drugs	011000000010000000000	30	90								30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	5	5								5												Specialty Drugs																							4
H4009	006	0	1	01	01	H4009_006_0	2	3	3	Formulary Brand	000010	3	1	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	1	2		011000000010000000000	Formulary Brand																						Formulary Brand	1.00	3.00								1.00												1	4
H4009	006	0	1	01	01	H4009_006_0	2	2	3	Formulary Preferred Brand	000001	3	1	Formulary Preferred Brand	011000000010000000000	30	90								30												Formulary Preferred Brand	1	2		011000000010000000000	Formulary Preferred Brand																						Formulary Preferred Brand	1.00	3.00								1.00												1	4
H4009	006	0	1	01	01	H4009_006_0	2	1	3	Generic	010000	3	1	Generic	011000000010000000000	30	30								30												Generic	1	2		011000000010000000000	Generic																						Generic	0.00	0.00								0.00												1	4
H4009	006	0	1	01	01	H4009_006_0	2	4	1	Specialty Drugs	000010	3	1	Specialty Drugs	011000000010000000000	30	90								30												Specialty Drugs	1	2		011000000010000000000	Specialty Drugs																						Specialty Drugs	1.00	3.00								1.00													4
H4009	006	0	1	01	01	H4009_006_0	2	3	1	Formulary Brand	000010	3	1	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	1	2		011000000010000000000	Formulary Brand																						Formulary Brand	1.00	3.00								1.00													4
H4009	006	0	1	01	01	H4009_006_0	2	2	1	Formulary Preferred Brand	000001	3	1	Formulary Preferred Brand	011000000010000000000	30	90								30												Formulary Preferred Brand	1	2		011000000010000000000	Formulary Preferred Brand																						Formulary Preferred Brand	1.00	3.00								1.00													4
H4009	006	0	1	01	01	H4009_006_0	2	1	1	Generic	010000	3	1	Generic	011000000010000000000	30	90								30												Generic	1	2		011000000010000000000	Generic																						Generic	0.00	0.00								0.00													4
H4009	006	0	1	01	01	H4009_006_0	2	4	3	Specialty Drugs	000010	3	1	Specialty Drugs	011000000010000000000	30	90								30												Specialty Drugs	1	2		011000000010000000000	Specialty Drugs																						Specialty Drugs	1.00	3.00								1.00												1	4
H4011	004	0	1	04	01	H4011_004_0	6	1	3	Generic	010000	1	2	Generic	010000000010000000000	30									30												Generic	2	2		010000000010000000000	Generic																						Generic	5.00									5.00												1	4
H4011	004	0	1	04	01	H4011_004_0	6	4	1	Specialty Drugs	010001	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	33									33												Specialty Drugs																							4
H4011	004	0	1	04	01	H4011_004_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	1	010000000010000000000		Non-Preferred Brand	30									30												Non-Preferred Brand																							4
H4011	004	0	1	04	01	H4011_004_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	010000000010000000000	30									30												Preferred Brand	2	1	010000000010000000000		Preferred Brand	20									20												Preferred Brand																							4
H4011	004	0	1	04	01	H4011_004_0	6	1	1	Generic	010000	1	2	Generic	010000000010000000000	30									30												Generic	2	2		010000000010000000000	Generic																						Generic	5.00									5.00													4
H4011	004	0	1	04	01	H4011_004_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4011	004	0	1	04	01	H4011_004_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4011	004	0	1	04	01	H4011_004_0	6	4	3	Specialty Drugs	010001	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H4011	008	0	1	04	01	H4011_008_0	6	1	3	Generic	010000	1	2	Generic	010000000010000000000	30									30												Generic	2	2		010000000010000000000	Generic																						Generic	5.00									5.00												1	4
H4011	008	0	1	04	01	H4011_008_0	6	4	1	Specialty Drugs	010001	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	33									33												Specialty Drugs																							4
H4011	008	0	1	04	01	H4011_008_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	1	010000000010000000000		Non-Preferred Brand	30									30												Non-Preferred Brand																							4
H4011	008	0	1	04	01	H4011_008_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	010000000010000000000	30									30												Preferred Brand	2	1	010000000010000000000		Preferred Brand	20									20												Preferred Brand																							4
H4011	008	0	1	04	01	H4011_008_0	6	1	1	Generic	010000	1	2	Generic	010000000010000000000	30									30												Generic	2	2		010000000010000000000	Generic																						Generic	5.00									5.00													4
H4011	008	0	1	04	01	H4011_008_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4011	008	0	1	04	01	H4011_008_0	6	4	3	Specialty Drugs	010001	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H4011	008	0	1	04	01	H4011_008_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4012	001	0	1	01	01	H4012_001_0	7	1	1	Generic	010000	3	2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	1.00	3.00	1.00							1.00	3.00	1.00		3.00									4
H4012	001	0	1	01	01	H4012_001_0	7	2	1	Preferred Brand	000011	3	2	Preferred Brand	011100000011101000000	30	90	15							30	90	15		90								Preferred Brand	2	2		011100000011101000000	Preferred Brand																						Preferred Brand	3.00	9.00	3.00							3.00	9.00	3.00		9.00									4
H4012	001	0	1	01	01	H4012_001_0	7	3	1	Brand	010010	3	2	Brand	011100000011101000000	30	90	15							30	90	15		90								Brand	1	2		011100000011101000000	Brand																						Brand	3.00	9.00	3.00							3.00	9.00	3.00		9.00									4
H4012	001	0	1	01	01	H4012_001_0	7	4	1	Non Preferred Drugs	100100	3	2	Non Preferred Drugs	011100000011101000000	30	90	15							30	90	15		90								Non Preferred Drugs	1	4	011100000011101000000	011100000011101000000	Non Preferred Drugs	25	25	25							25	25	25		25								Non Preferred Drugs	10.00	30.00	10.00							10.00	30.00	10.00		30.00									4
H4012	003	0	1	01	01	H4012_003_0	8	1	1	Generic	010000	3	2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00									4
H4012	003	0	1	01	01	H4012_003_0	8	2	1	Preferred Brand	000011	3	2	Preferred Brand	011100000011101000000	30	90	15							30	90	15		90								Preferred Brand	2	2		011100000011101000000	Preferred Brand																						Preferred Brand	0.50	1.50	0.50							0.50	1.50	0.50		1.50									4
H4012	003	0	1	01	01	H4012_003_0	8	4	1	Non Preferred Drugs	100100	3	2	Non Preferred Drugs	011100000011101000000	30	90	15							30	90	15		90								Non Preferred Drugs	1	4	011100000011101000000	011100000011101000000	Non Preferred Drugs	25	25	25							25	25	25		25								Non Preferred Drugs	10.00	30.00	10.00							10.00	30.00	10.00		30.00									4
H4012	003	0	1	01	01	H4012_003_0	8	3	1	Brand	010010	3	2	Brand	011100000011101000000	30	90	15							30	90	15		90								Brand	1	2		011100000011101000000	Brand																						Brand	0.50	1.50	0.50							0.50	1.50	0.50		1.50									4
H4012	004	0	1	01	01	H4012_004_0	8	1	1	Generic	010000	3	2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00									4
H4012	004	0	1	01	01	H4012_004_0	8	2	1	Preferred Brand	000011	3	2	Preferred Brand	011100000011101000000	30	90	15							30	90	15		90								Preferred Brand	2	2		011100000011101000000	Preferred Brand																						Preferred Brand	0.50	1.50	0.50							0.50	1.50	0.50		1.50									4
H4012	004	0	1	01	01	H4012_004_0	8	3	1	Brand	010010	3	2	Brand	011100000011101000000	30	90	15							30	90	15		90								Brand	1	2		011100000011101000000	Brand																						Brand	0.50	1.50	0.50							0.50	1.50	0.50		1.50									4
H4012	004	0	1	01	01	H4012_004_0	8	4	1	Non Preferred Drugs	100100	3	2	Non Preferred Drugs	011100000011101000000	30	90	15							30	90	15		90								Non Preferred Drugs	1	4	011100000011101000000	011100000011101000000	Non Preferred Drugs	25	25	25							25	25	25		25								Non Preferred Drugs	10.00	30.00	10.00							10.00	30.00	10.00		30.00									4
H4102	001	0	1	01	01	H4102_001_0	10	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H4102	001	0	1	01	01	H4102_001_0	10	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H4102	001	0	1	01	01	H4102_001_0	10	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H4102	001	0	1	01	01	H4102_001_0	10	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4106	001	0	1	01	01	H4106_001_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H4106	001	0	1	01	01	H4106_001_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4106	001	0	1	01	01	H4106_001_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H4106	001	0	1	01	01	H4106_001_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H4152	005	0	1	01	01	H4152_005_0	6	4	1	Tier 4	010010	1	2	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4152	005	0	1	01	01	H4152_005_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	54.00	162.00								54.00				135.00									4
H4152	005	0	1	01	01	H4152_005_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	24.00	72.00								24.00				60.00									4
H4152	005	0	1	01	01	H4152_005_0	6	5	1	Tier 5	010010	1	1	Tier 5	011000000010001000000	30	90								30				90								Tier 5	2	1	011000000010001000000		Tier 5	25	25								25				25								Tier 5																							4
H4152	005	0	1	01	01	H4152_005_0	6	1	1	Tier 1	001000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				20.00									4
H4152	007	0	1	02	01	H4152_007_0	9	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4152	007	0	1	02	01	H4152_007_0	9	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4152	007	0	1	02	01	H4152_007_0	9	4	3	Tier 4	010010	1	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4152	007	0	1	02	01	H4152_007_0	9	5	3	Tier 5	010010	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
H4152	007	0	1	02	01	H4152_007_0	9	1	3	Tier 1	001000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				20.00								1	4
H4152	007	0	1	02	01	H4152_007_0	9	5	1	Tier 5	010010	1	1	Tier 5	011000000010001000000	30	90								30				90								Tier 5	2	1	011000000010001000000		Tier 5	25	25								25				25								Tier 5																							4
H4152	007	0	1	02	01	H4152_007_0	9	4	1	Tier 4	010010	1	2	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4152	007	0	1	02	01	H4152_007_0	9	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	50.00	150.00								50.00				125.00									4
H4152	007	0	1	02	01	H4152_007_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	20.00	60.00								20.00				50.00									4
H4152	007	0	1	02	01	H4152_007_0	9	1	1	Tier 1	001000	3	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				20.00									4
H4152	012	0	1	01	01	H4152_012_0	7	1	1	Tier 1	001000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	0.00	0.00								0.00				0.00									3
H4152	012	0	1	01	01	H4152_012_0	7	2	1	Tier 2	000001		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				100.00									3
H4152	012	0	1	01	01	H4152_012_0	7	3	1	Tier 3	100000		2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	74.00	222.00								74.00				185.00									3
H4152	012	0	1	01	01	H4152_012_0	7	5	1	Tier 5	010010		1	Tier 5	011000000010001000000	30	90								30				90								Tier 5	2	1	011000000010001000000		Tier 5	25	25								25				25								Tier 5																							3
H4152	012	0	1	01	01	H4152_012_0	7	4	1	Tier 4	010010		2	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							3
H4152	013	0	1	01	01	H4152_013_0	7	5	1	Tier 5	010010		1	Tier 5	011000000010001000000	30	90								30				90								Tier 5	2	1	011000000010001000000		Tier 5	25	25								25				25								Tier 5																							3
H4152	013	0	1	01	01	H4152_013_0	7	3	1	Tier 3	100000		2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	61.00	183.00								61.00				152.50									3
H4152	013	0	1	01	01	H4152_013_0	7	2	1	Tier 2	000001		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	30.00	90.00								30.00				75.00									3
H4152	013	0	1	01	01	H4152_013_0	7	1	1	Tier 1	001000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	10.00	30.00								10.00				25.00									3
H4152	013	0	1	01	01	H4152_013_0	7	4	1	Tier 4	010010		2	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							3
H4206	001	0	1	04	01	H4206_001_0	6	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									3
H4206	001	0	1	04	01	H4206_001_0	6	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4206	001	0	1	04	01	H4206_001_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	125.00								50.00				100.00									3
H4206	001	0	1	04	01	H4206_001_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									3
H4206	002	0	1	04	01	H4206_002_0	5	4	1	Specialty	000010	1	1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H4206	002	0	1	04	01	H4206_002_0	5	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00								1	4
H4206	002	0	1	04	01	H4206_002_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4206	002	0	1	04	01	H4206_002_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4206	002	0	1	04	01	H4206_002_0	5	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4206	002	0	1	04	01	H4206_002_0	5	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									4
H4206	002	0	1	04	01	H4206_002_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									4
H4206	002	0	1	04	01	H4206_002_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	125.00								50.00				100.00									4
H4206	005	0	1	04	01	H4206_005_0	6	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									3
H4206	005	0	1	04	01	H4206_005_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									3
H4206	005	0	1	04	01	H4206_005_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	125.00								50.00				100.00									3
H4206	005	0	1	04	01	H4206_005_0	6	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4206	006	0	1	04	01	H4206_006_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	125.00								50.00				100.00									4
H4206	006	0	1	04	01	H4206_006_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									4
H4206	006	0	1	04	01	H4206_006_0	5	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									4
H4206	006	0	1	04	01	H4206_006_0	5	4	1	Specialty	000010	1	1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H4206	006	0	1	04	01	H4206_006_0	5	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4206	006	0	1	04	01	H4206_006_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4206	006	0	1	04	01	H4206_006_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4206	006	0	1	04	01	H4206_006_0	5	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00								1	4
H4206	007	0	1	04	01	H4206_007_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									3
H4206	007	0	1	04	01	H4206_007_0	6	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									3
H4206	007	0	1	04	01	H4206_007_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	125.00								50.00				100.00									3
H4206	007	0	1	04	01	H4206_007_0	6	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4206	008	0	1	04	01	H4206_008_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	125.00								50.00				100.00									4
H4206	008	0	1	04	01	H4206_008_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									4
H4206	008	0	1	04	01	H4206_008_0	5	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									4
H4206	008	0	1	04	01	H4206_008_0	5	4	1	Specialty	000010	1	1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H4206	008	0	1	04	01	H4206_008_0	5	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4206	008	0	1	04	01	H4206_008_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4206	008	0	1	04	01	H4206_008_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4206	008	0	1	04	01	H4206_008_0	5	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00								1	4
H4206	009	0	1	04	01	H4206_009_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	125.00								50.00				100.00									3
H4206	009	0	1	04	01	H4206_009_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									3
H4206	009	0	1	04	01	H4206_009_0	6	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									3
H4206	009	0	1	04	01	H4206_009_0	6	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4206	010	0	1	04	01	H4206_010_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	125.00								50.00				100.00									4
H4206	010	0	1	04	01	H4206_010_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									4
H4206	010	0	1	04	01	H4206_010_0	6	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									4
H4206	010	0	1	04	01	H4206_010_0	6	4	1	Specialty	000010	1	1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H4206	010	0	1	04	01	H4206_010_0	6	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4206	010	0	1	04	01	H4206_010_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4206	010	0	1	04	01	H4206_010_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4206	010	0	1	04	01	H4206_010_0	6	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00								1	4
H4206	025	0	1	04	01	H4206_025_0	6	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									3
H4206	025	0	1	04	01	H4206_025_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	23.00	69.00								23.00				69.00									3
H4206	025	0	1	04	01	H4206_025_0	6	3	1	NonPreferred Brand	100000		2	NonPreferred Brand	011000000010001000000	34	90								34				90								NonPreferred Brand	2	1	011000000010001000000		NonPreferred Brand	50	50								50				50								NonPreferred Brand																							3
H4206	025	0	1	04	01	H4206_025_0	6	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4207	001	0	1	04	01	H4207_001_0	8	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	1	011000000010001000000		Non-Preferred Brand	33	33								33				33								Non-Preferred Brand																							3
H4207	001	0	1	04	01	H4207_001_0	8	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	28.00	84.00								28.00				70.00									3
H4207	001	0	1	04	01	H4207_001_0	8	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									3
H4207	001	0	1	04	01	H4207_001_0	8	4	1	Specialty	000010		1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4207	002	0	1	04	01	H4207_002_0	8	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									3
H4207	002	0	1	04	01	H4207_002_0	8	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	28.00	84.00								28.00				70.00									3
H4207	002	0	1	04	01	H4207_002_0	8	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	1	011000000010001000000		Non-Preferred Brand	33	33								33				33								Non-Preferred Brand																							3
H4207	002	0	1	04	01	H4207_002_0	8	4	1	Specialty	000010		1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4207	003	0	1	04	01	H4207_003_0	8	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	1	011000000010001000000		Non-Preferred Brand	33	33								33				33								Non-Preferred Brand																							3
H4207	003	0	1	04	01	H4207_003_0	8	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	28.00	84.00								28.00				70.00									3
H4207	003	0	1	04	01	H4207_003_0	8	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									3
H4207	003	0	1	04	01	H4207_003_0	8	4	1	Specialty	000010		1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4207	004	0	1	04	01	H4207_004_0	8	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	1	011000000010001000000		Non-Preferred Brand	33	33								33				33								Non-Preferred Brand																							3
H4207	004	0	1	04	01	H4207_004_0	8	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	28.00	84.00								28.00				70.00									3
H4207	004	0	1	04	01	H4207_004_0	8	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									3
H4207	004	0	1	04	01	H4207_004_0	8	4	1	Specialty	000010		1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4207	005	0	1	04	01	H4207_005_0	9	1	3	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00								1	4
H4207	005	0	1	04	01	H4207_005_0	9	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4207	005	0	1	04	01	H4207_005_0	9	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4207	005	0	1	04	01	H4207_005_0	9	4	1	Specialty	000010	1	1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H4207	005	0	1	04	01	H4207_005_0	9	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	1	011000000010001000000		Non-Preferred Brand	33	33								33				33								Non-Preferred Brand																							4
H4207	005	0	1	04	01	H4207_005_0	9	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4207	005	0	1	04	01	H4207_005_0	9	1	1	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									4
H4207	005	0	1	04	01	H4207_005_0	9	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	28.00	84.00								28.00				70.00									4
H4208	001	0	1	02	01	H4208_001_0	4	3	1	Tier 3	000001		1	Tier 3	010000000010010010000	30									30			30			30						Tier 3	2	1	010000000010010010000		Tier 3	25									25			25			22						Tier 3																							2
H4208	001	0	1	02	01	H4208_001_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	21.00	63.00								21.00				63.00									2
H4208	001	0	1	02	01	H4208_001_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				15.00									2
H4208	002	0	1	02	01	H4208_002_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				15.00									2
H4208	002	0	1	02	01	H4208_002_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	21.00	63.00								21.00				63.00									2
H4208	002	0	1	02	01	H4208_002_0	3	3	1	Tier 3	000001		1	Tier 3	010000000010010010000	30									30			30			30						Tier 3	2	1	010000000010010010000		Tier 3	25									25			25			22						Tier 3																							2
H4208	008	0	1	02	01	H4208_008_0	4	4	1	Tier 4	000001	1	1	Tier 4	010000000010010010000	30									30			30			30						Tier 4	2	1	010000000010010010000		Tier 4	33									33			33			30						Tier 4																							4
H4208	008	0	1	02	01	H4208_008_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	55.00	110.00								55.00				110.00									4
H4208	008	0	1	02	01	H4208_008_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	30.00	60.00								30.00				60.00									4
H4208	008	0	1	02	01	H4208_008_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	10.00								5.00				10.00									4
H4208	008	0	1	02	01	H4208_008_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	10.00								5.00				10.00								1	4
H4208	008	0	1	02	01	H4208_008_0	4	4	3	Tier 4	000001	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4208	008	0	1	02	01	H4208_008_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4208	008	0	1	02	01	H4208_008_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4208	009	0	1	02	01	H4208_009_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	10.00								5.00				10.00									4
H4208	009	0	1	02	01	H4208_009_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	30.00	60.00								30.00				60.00									4
H4208	009	0	1	02	01	H4208_009_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	55.00	110.00								55.00				110.00									4
H4208	009	0	1	02	01	H4208_009_0	3	4	1	Tier 4	000001	1	1	Tier 4	010000000010010010000	30									30			30			30						Tier 4	2	1	010000000010010010000		Tier 4	33									33			33			30						Tier 4																							4
H4208	009	0	1	02	01	H4208_009_0	3	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4208	009	0	1	02	01	H4208_009_0	3	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4208	009	0	1	02	01	H4208_009_0	3	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	10.00								5.00				10.00								1	4
H4208	009	0	1	02	01	H4208_009_0	3	4	3	Tier 4	000001	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4209	001	0	1	04	01	H4209_001_0	5	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	12.00								9.00				12.00									3
H4209	001	0	1	04	01	H4209_001_0	5	2	1	Brand	000010		2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	32.00	64.00								48.00				64.00									3
H4209	001	0	1	04	01	H4209_001_0	5	3	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4209	002	0	1	04	01	H4209_002_0	5	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	12.00								9.00				12.00									3
H4209	002	0	1	04	01	H4209_002_0	5	2	1	Brand	000010		2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	32.00	64.00								48.00				64.00									3
H4209	002	0	1	04	01	H4209_002_0	5	3	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4209	003	0	1	04	01	H4209_003_0	5	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	12.00								9.00				12.00									3
H4209	003	0	1	04	01	H4209_003_0	5	2	1	Brand	000010		2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	32.00	64.00								48.00				64.00									3
H4209	003	0	1	04	01	H4209_003_0	5	3	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4209	004	0	1	04	01	H4209_004_0	5	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	12.00								9.00				12.00									3
H4209	004	0	1	04	01	H4209_004_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	52.00								39.00				52.00									3
H4209	004	0	1	04	01	H4209_004_0	5	4	1	Specialty	010010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4209	004	0	1	04	01	H4209_004_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	56.00	112.00								84.00				112.00									3
H4209	005	0	1	04	01	H4209_005_0	5	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	12.00								9.00				12.00									3
H4209	005	0	1	04	01	H4209_005_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	52.00								39.00				52.00									3
H4209	005	0	1	04	01	H4209_005_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	56.00	112.00								84.00				112.00									3
H4209	005	0	1	04	01	H4209_005_0	5	4	1	Specialty	010010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4209	006	0	1	04	01	H4209_006_0	5	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	12.00								9.00				12.00									3
H4209	006	0	1	04	01	H4209_006_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	56.00	112.00								84.00				112.00									3
H4209	006	0	1	04	01	H4209_006_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	52.00								39.00				52.00									3
H4209	006	0	1	04	01	H4209_006_0	5	4	1	Specialty	010010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
H4406	001	0	1	02	01	H4406_001_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H4406	001	0	1	02	01	H4406_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H4406	001	0	1	02	01	H4406_001_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4406	001	0	1	02	01	H4406_001_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H4406	004	0	1	01	01	H4406_004_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H4406	004	0	1	01	01	H4406_004_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H4406	004	0	1	01	01	H4406_004_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4406	004	0	1	01	01	H4406_004_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H4407	001	0	1	01	01	H4407_001_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H4407	001	0	1	01	01	H4407_001_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H4407	001	0	1	01	01	H4407_001_0	3	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H4407	001	0	1	01	01	H4407_001_0	3	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H4407	001	0	1	01	01	H4407_001_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H4407	001	0	1	01	01	H4407_001_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4407	001	0	1	01	01	H4407_001_0	3	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H4407	001	0	1	01	01	H4407_001_0	3	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4407	002	0	1	01	01	H4407_002_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H4407	002	0	1	01	01	H4407_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4407	002	0	1	01	01	H4407_002_0	3	3	3	Injectables	000001	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
H4407	002	0	1	01	01	H4407_002_0	3	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4407	002	0	1	01	01	H4407_002_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H4407	002	0	1	01	01	H4407_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H4407	002	0	1	01	01	H4407_002_0	3	3	1	Injectables	000001	1	2	Injectables	011000000011001000000	30	90								30	90			90								Injectables	1	1	011000000011001000000		Injectables	50	50								50	50			50								Injectables																							4
H4407	002	0	1	01	01	H4407_002_0	3	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	1	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H4407	007	0	1	01	01	H4407_007_0	6	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H4407	007	0	1	01	01	H4407_007_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H4407	007	0	1	01	01	H4407_007_0	6	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H4407	007	0	1	01	01	H4407_007_0	6	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H4407	007	0	1	01	01	H4407_007_0	6	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4407	007	0	1	01	01	H4407_007_0	6	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H4407	007	0	1	01	01	H4407_007_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4407	007	0	1	01	01	H4407_007_0	6	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H4407	008	0	1	01	01	H4407_008_0	4	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H4407	008	0	1	01	01	H4407_008_0	4	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4407	008	0	1	01	01	H4407_008_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4407	008	0	1	01	01	H4407_008_0	4	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H4407	008	0	1	01	01	H4407_008_0	4	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H4407	008	0	1	01	01	H4407_008_0	4	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H4407	008	0	1	01	01	H4407_008_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H4407	008	0	1	01	01	H4407_008_0	4	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H4408	001	0	1	04	01	H4408_001_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H4408	001	0	1	04	01	H4408_001_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H4408	001	0	1	04	01	H4408_001_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H4408	001	0	1	04	01	H4408_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4408	002	0	1	04	01	H4408_002_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4408	002	0	1	04	01	H4408_002_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H4408	002	0	1	04	01	H4408_002_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H4408	002	0	1	04	01	H4408_002_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H4454	002	0	1	01	01	H4454_002_0	4	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H4454	002	0	1	01	01	H4454_002_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H4454	002	0	1	01	01	H4454_002_0	4	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4454	002	0	1	01	01	H4454_002_0	4	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H4454	002	0	1	01	01	H4454_002_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4454	002	0	1	01	01	H4454_002_0	4	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H4454	002	0	1	01	01	H4454_002_0	4	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H4454	002	0	1	01	01	H4454_002_0	4	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H4454	013	0	1	01	01	H4454_013_0	3	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H4454	013	0	1	01	01	H4454_013_0	3	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H4454	013	0	1	01	01	H4454_013_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4454	013	0	1	01	01	H4454_013_0	3	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H4454	013	0	1	01	01	H4454_013_0	3	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H4454	013	0	1	01	01	H4454_013_0	3	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H4454	013	0	1	01	01	H4454_013_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H4454	013	0	1	01	01	H4454_013_0	3	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4456	010	0	1	01	01	H4456_010_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000001001	30	90								30	90						90			90		Non-Preferred Brand	2	2		011000000011000001001	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00						174.00			174.00			4
H4456	010	0	1	01	01	H4456_010_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000001001	30	90								30	90						90			90		Preferred Brand	2	2		011000000011000001001	Preferred Brand																						Preferred Brand	28.00	84.00								28.00	84.00						84.00			84.00			4
H4456	010	0	1	01	01	H4456_010_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011000001001	30	90								30	90						90			90		Preferred Generic	2	2		011000000011000001001	Preferred Generic																						Preferred Generic	3.00	9.00								3.00	9.00						9.00			9.00			4
H4456	010	0	1	01	01	H4456_010_0	6	4	1	Specialty	101001	1	1	Specialty	011000000011000001001	30	90								30	90						90			90		Specialty	2	1	011000000011000001001		Specialty	33	33								33	33						33			33		Specialty																							4
H4456	013	0	1	01	01	H4456_013_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011000001001	30	90								30	90						90			90		Preferred Generic	2	2		011000000011000001001	Preferred Generic																						Preferred Generic	3.00	9.00								3.00	9.00						9.00			9.00			4
H4456	013	0	1	01	01	H4456_013_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000001001	30	90								30	90						90			90		Preferred Brand	2	2		011000000011000001001	Preferred Brand																						Preferred Brand	28.00	84.00								28.00	84.00						84.00			84.00			4
H4456	013	0	1	01	01	H4456_013_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000001001	30	90								30	90						90			90		Non-Preferred Brand	2	2		011000000011000001001	Non-Preferred Brand																						Non-Preferred Brand	58.00	174.00								58.00	174.00						174.00			174.00			4
H4456	013	0	1	01	01	H4456_013_0	5	4	1	Specialty	101001	1	1	Specialty	011000000011000001001	30	90								30	90						90			90		Specialty	2	1	011000000011000001001		Specialty	33	33								33	33						33			33		Specialty																							4
H4456	015	0	1	01	01	H4456_015_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011000001001	30	90								30	90						90			90		Preferred Generic	2	2		011000000011000001001	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	015	0	1	01	01	H4456_015_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000001001	30	90								30	90						90			90		Preferred Brand	2	2		011000000011000001001	Preferred Brand																						Preferred Brand	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	015	0	1	01	01	H4456_015_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000001001	30	90								30	90						90			90		Non-Preferred Brand	2	2		011000000011000001001	Non-Preferred Brand																						Non-Preferred Brand	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	015	0	1	01	01	H4456_015_0	3	4	1	Specialty	101001	1	1	Specialty	011000000011000001001	30	90								30	90						90			90		Specialty	2	1	011000000011000001001		Specialty	33	33								33	33						33			33		Specialty																							4
H4456	017	0	1	01	01	H4456_017_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011000001001	30	90								30	90						90			90		Preferred Generic	2	2		011000000011000001001	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	017	0	1	01	01	H4456_017_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000001001	30	90								30	90						90			90		Preferred Brand	2	2		011000000011000001001	Preferred Brand																						Preferred Brand	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	017	0	1	01	01	H4456_017_0	3	4	1	Specialty	101001	1	1	Specialty	011000000011000001001	30	90								30	90						90			90		Specialty	2	1	011000000011000001001		Specialty	33	33								33	33						33			33		Specialty																							4
H4456	017	0	1	01	01	H4456_017_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000001001	30	90								30	90						90			90		Non-Preferred Brand	2	2		011000000011000001001	Non-Preferred Brand																						Non-Preferred Brand	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	019	0	1	01	01	H4456_019_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011000001001	30	90								30	90						90			90		Preferred Generic	2	2		011000000011000001001	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	019	0	1	01	01	H4456_019_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000001001	30	90								30	90						90			90		Preferred Brand	2	2		011000000011000001001	Preferred Brand																						Preferred Brand	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	019	0	1	01	01	H4456_019_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000001001	30	90								30	90						90			90		Non-Preferred Brand	2	2		011000000011000001001	Non-Preferred Brand																						Non-Preferred Brand	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	019	0	1	01	01	H4456_019_0	4	4	1	Specialty	101001	1	1	Specialty	011000000011000001001	30	90								30	90						90			90		Specialty	2	1	011000000011000001001		Specialty	33	33								33	33						33			33		Specialty																							4
H4456	021	0	1	01	01	H4456_021_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011000001001	30	90								30	90						90			90		Preferred Generic	2	2		011000000011000001001	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	021	0	1	01	01	H4456_021_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000001001	30	90								30	90						90			90		Non-Preferred Brand	2	2		011000000011000001001	Non-Preferred Brand																						Non-Preferred Brand	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	021	0	1	01	01	H4456_021_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000001001	30	90								30	90						90			90		Preferred Brand	2	2		011000000011000001001	Preferred Brand																						Preferred Brand	10.00	30.00								10.00	30.00						30.00			30.00			4
H4456	021	0	1	01	01	H4456_021_0	4	4	1	Specialty	101001	1	1	Specialty	011000000011000001001	30	90								30	90						90			90		Specialty	2	1	011000000011000001001		Specialty	33	33								33	33						33			33		Specialty																							4
H4461	001	0	1	01	01	H4461_001_0	11	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Non-preferred Brand	2	2		000011011011011000000	Non-preferred Brand																						Non-preferred Brand				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	001	0	1	01	01	H4461_001_0	11	2	1	Preferred Brand	000001		2	Preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Preferred Brand	2	2		000011011011011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00									3
H4461	001	0	1	01	01	H4461_001_0	11	1	1	Generics	010000		2	Generics	000011011011011000000				30	90		30	90		30	90		30	90								Generics	2	2		000011011011011000000	Generics																						Generics				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00									3
H4461	001	0	1	01	01	H4461_001_0	11	4	1	Biologicals and Injectibles	010010		1	Biologicals and Injectibles	000011011011011000000				30	90		30	90		30	90		30	90								Biologicals and Injectibles	2	2		000011011011011000000	Biologicals and Injectibles																						Biologicals and Injectibles				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	011	0	1	01	01	H4461_011_0	17	3	1	Tier 3	000010		2	Tier 3	000011011011011000000				30	90		30	90		30	90		30	90								Tier 3	2	2		000011011011011000000	Tier 3																						Tier 3				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	011	0	1	01	01	H4461_011_0	17	2	1	Tier 2	000001		2	Tier 2	000011011011011000000				30	90		30	90		30	90		30	90								Tier 2	2	2		000011011011011000000	Tier 2																						Tier 2				25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00									3
H4461	011	0	1	01	01	H4461_011_0	17	1	1	Tier 1	010000		2	Tier 1	000011011011011000000				30	90		30	90		30	90		30	90								Tier 1	2	2		000011011011011000000	Tier 1																						Tier 1				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00									3
H4461	011	0	1	01	01	H4461_011_0	17	4	1	Tier 4	000010		1	Tier 4	000011011011011000000				30	90		30	90		30	90		30	90								Tier 4	2	2		000011011011011000000	Tier 4																						Tier 4				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	012	0	1	01	01	H4461_012_0	9	1	1	Generics	010000		2	Generics	000011011011011000000				30	90		30	90		30	90		30	90								Generics	2	2		000011011011011000000	Generics																						Generics				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00									3
H4461	012	0	1	01	01	H4461_012_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Preferred Brand	2	2		000011011011011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00									3
H4461	012	0	1	01	01	H4461_012_0	9	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Non-preferred Brand	2	2		000011011011011000000	Non-preferred Brand																						Non-preferred Brand				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	012	0	1	01	01	H4461_012_0	9	4	1	Biologicals and Injectibles	010010		1	Biologicals and Injectibles	000011011011011000000				30	90		30	90		30	90		30	90								Biologicals and Injectibles	2	2		000011011011011000000	Biologicals and Injectibles																						Biologicals and Injectibles				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	013	0	1	01	01	H4461_013_0	14	1	1	Tier 1	010000		2	Tier 1	000011011011011000000				30	90		30	90		30	90		30	90								Tier 1	2	2		000011011011011000000	Tier 1																						Tier 1				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00									3
H4461	013	0	1	01	01	H4461_013_0	14	2	1	Tier 2	000001		2	Tier 2	000011011011011000000				30	90		30	90		30	90		30	90								Tier 2	2	2		000011011011011000000	Tier 2																						Tier 2				25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00									3
H4461	013	0	1	01	01	H4461_013_0	14	3	1	Tier 3	000010		2	Tier 3	000011011011011000000				30	90		30	90		30	90		30	90								Tier 3	2	2		000011011011011000000	Tier 3																						Tier 3				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	013	0	1	01	01	H4461_013_0	14	4	1	Tier 4	000010		1	Tier 4	000011011011011000000				30	90		30	90		30	90		30	90								Tier 4	2	2		000011011011011000000	Tier 4																						Tier 4				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	015	0	1	01	01	H4461_015_0	15	1	1	Generics	010000		2	Generics	000011011011011000000				30	90		30	90		30	90		30	90								Generics	2	2		000011011011011000000	Generics																						Generics				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00									3
H4461	015	0	1	01	01	H4461_015_0	15	2	1	Preferred Brand	000001		2	Preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Preferred Brand	2	2		000011011011011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00									3
H4461	015	0	1	01	01	H4461_015_0	15	4	1	Biologicals and Injectibles	010010		2	Biologicals and Injectibles	000011011011011000000				30	90		30	90		30	90		30	90								Biologicals and Injectibles	2	2		000011011011011000000	Biologicals and Injectibles																						Biologicals and Injectibles				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	015	0	1	01	01	H4461_015_0	15	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Non-preferred Brand	2	2		000011011011011000000	Non-preferred Brand																						Non-preferred Brand				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H4461	016	0	1	01	01	H4461_016_0	9	1	1	Generics	010000	1	2	Generics	000011011011011000000				30	90		30	90		30	90		30	90								Generics	2	2		000011011011011000000	Generics																						Generics				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00									4
H4461	016	0	1	01	01	H4461_016_0	9	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Preferred Brand	2	2		000011011011011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00									4
H4461	016	0	1	01	01	H4461_016_0	9	4	3	Biologicals and Injectibles	010010	1	1	Biologicals and Injectibles																							Biologicals and Injectibles					Biologicals and Injectibles																						Biologicals and Injectibles																						2	4
H4461	016	0	1	01	01	H4461_016_0	9	3	3	Non-preferred Brand	100000	1	2	Non-preferred Brand																							Non-preferred Brand					Non-preferred Brand																						Non-preferred Brand																						2	4
H4461	016	0	1	01	01	H4461_016_0	9	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4461	016	0	1	01	01	H4461_016_0	9	1	3	Generics	010000	1	2	Generics	000011011011011000000				30	90		30	90		30	90		30	90								Generics	2	2		000011011011011000000	Generics																						Generics				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00								1	4
H4461	016	0	1	01	01	H4461_016_0	9	4	1	Biologicals and Injectibles	010010	1	1	Biologicals and Injectibles	000011011011011000000				30	90		30	90		30	90		30	90								Biologicals and Injectibles	2	2		000011011011011000000	Biologicals and Injectibles																						Biologicals and Injectibles				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									4
H4461	016	0	1	01	01	H4461_016_0	9	3	1	Non-preferred Brand	100000	1	2	Non-preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Non-preferred Brand	2	2		000011011011011000000	Non-preferred Brand																						Non-preferred Brand				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									4
H4461	017	0	1	01	01	H4461_017_0	15	1	1	Generics	010000	1	2	Generics	000011011011011000000				30	90		30	90		30	90		30	90								Generics	2	2		000011011011011000000	Generics																						Generics				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00									4
H4461	017	0	1	01	01	H4461_017_0	15	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4461	017	0	1	01	01	H4461_017_0	15	3	3	Non-preferred Brand	100000	1	2	Non-preferred Brand																							Non-preferred Brand					Non-preferred Brand																						Non-preferred Brand																						2	4
H4461	017	0	1	01	01	H4461_017_0	15	1	3	Generics	010000	1	2	Generics	000011011011011000000				30	90		30	90		30	90		30	90								Generics	2	2		000011011011011000000	Generics																						Generics				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00								1	4
H4461	017	0	1	01	01	H4461_017_0	15	4	1	Biologicals and Injectibles	010010	1	1	Biologicals and Injectibles	000011011011011000000				30	90		30	90		30	90		30	90								Biologicals and Injectibles	2	2		000011011011011000000	Biologicals and Injectibles																						Biologicals and Injectibles				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									4
H4461	017	0	1	01	01	H4461_017_0	15	3	1	Non-preferred Brand	100000	1	2	Non-preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Non-preferred Brand	2	2		000011011011011000000	Non-preferred Brand																						Non-preferred Brand				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									4
H4461	017	0	1	01	01	H4461_017_0	15	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Preferred Brand	2	2		000011011011011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00									4
H4461	017	0	1	01	01	H4461_017_0	15	4	3	Biologicals and Injectibles	010010	1	1	Biologicals and Injectibles																							Biologicals and Injectibles					Biologicals and Injectibles																						Biologicals and Injectibles																						2	4
H4506	003	0	1	05	01	H4506_003_0	3	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H4506	003	0	1	05	01	H4506_003_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H4506	003	0	1	05	01	H4506_003_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H4506	003	0	1	05	01	H4506_003_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4506	003	0	1	05	01	H4506_003_0	3	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00								1	4
H4506	003	0	1	05	01	H4506_003_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4506	003	0	1	05	01	H4506_003_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4506	003	0	1	05	01	H4506_003_0	3	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H4506	004	0	1	05	01	H4506_004_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4506	004	0	1	05	01	H4506_004_0	3	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H4506	004	0	1	05	01	H4506_004_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H4506	004	0	1	05	01	H4506_004_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H4506	004	0	1	05	01	H4506_004_0	3	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H4506	004	0	1	05	01	H4506_004_0	3	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00								1	4
H4506	004	0	1	05	01	H4506_004_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4506	004	0	1	05	01	H4506_004_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4506	015	0	1	05	01	H4506_015_0	3	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H4506	015	0	1	05	01	H4506_015_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H4506	015	0	1	05	01	H4506_015_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H4506	015	0	1	05	01	H4506_015_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4506	015	0	1	05	01	H4506_015_0	3	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00								1	4
H4506	015	0	1	05	01	H4506_015_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4506	015	0	1	05	01	H4506_015_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4506	015	0	1	05	01	H4506_015_0	3	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H4510	012	0	1	01	01	H4510_012_0	6	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H4510	012	0	1	01	01	H4510_012_0	6	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	50.00									4
H4510	012	0	1	01	01	H4510_012_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	40.00	120.00								40.00			40.00	100.00									4
H4510	012	0	1	01	01	H4510_012_0	6	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4510	012	0	1	01	01	H4510_012_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4510	012	0	1	01	01	H4510_012_0	6	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00								1	4
H4510	012	0	1	01	01	H4510_012_0	6	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4510	012	0	1	01	01	H4510_012_0	6	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H4510	015	0	1	01	01	H4510_015_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4510	015	0	1	01	01	H4510_015_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H4510	015	0	1	01	01	H4510_015_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	62.50									4
H4510	015	0	1	01	01	H4510_015_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	40.00	120.00								40.00			40.00	100.00									4
H4510	015	0	1	01	01	H4510_015_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4510	015	0	1	01	01	H4510_015_0	3	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
H4510	015	0	1	01	01	H4510_015_0	3	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
H4510	015	0	1	01	01	H4510_015_0	3	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4510	016	0	1	01	01	H4510_016_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H4510	016	0	1	01	01	H4510_016_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H4510	016	0	1	01	01	H4510_016_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	28									28			28									Specialty																							4
H4510	016	0	1	01	01	H4510_016_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H4510	017	0	1	01	01	H4510_017_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	100.00									4
H4510	017	0	1	01	01	H4510_017_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	85.00	255.00								85.00			85.00	212.50									4
H4510	017	0	1	01	01	H4510_017_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	28									28			28									Specialty																							4
H4510	017	0	1	01	01	H4510_017_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00									4
H4513	001	0	1	01	01	H4513_001_0	7	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H4513	001	0	1	01	01	H4513_001_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00			90.00									4
H4513	001	0	1	01	01	H4513_001_0	7	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H4513	001	0	1	01	01	H4513_001_0	7	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4513	001	0	1	01	01	H4513_001_0	7	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H4513	001	0	1	01	01	H4513_001_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4513	001	0	1	01	01	H4513_001_0	7	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H4513	001	0	1	01	01	H4513_001_0	7	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H4513	006	0	1	01	01	H4513_006_0	4	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H4513	006	0	1	01	01	H4513_006_0	4	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H4513	006	0	1	01	01	H4513_006_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H4513	006	0	1	01	01	H4513_006_0	4	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H4513	006	0	1	01	01	H4513_006_0	4	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4513	006	0	1	01	01	H4513_006_0	4	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H4513	006	0	1	01	01	H4513_006_0	4	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H4513	006	0	1	01	01	H4513_006_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4513	015	0	1	01	01	H4513_015_0	4	3	3	Plan Approved Alternative	100001	1	2	Plan Approved Alternative																							Plan Approved Alternative					Plan Approved Alternative																						Plan Approved Alternative																						2	4
H4513	015	0	1	01	01	H4513_015_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4513	015	0	1	01	01	H4513_015_0	4	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00								1	4
H4513	015	0	1	01	01	H4513_015_0	4	4	1	Specialty	000001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H4513	015	0	1	01	01	H4513_015_0	4	3	1	Plan Approved Alternative	100001	1	2	Plan Approved Alternative	011000000011001000000	30	90								30	90			90								Plan Approved Alternative	2	1	011000000011001000000		Plan Approved Alternative	50	50								50	50			50								Plan Approved Alternative																							4
H4513	015	0	1	01	01	H4513_015_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									4
H4513	015	0	1	01	01	H4513_015_0	4	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									4
H4513	015	0	1	01	01	H4513_015_0	4	4	3	Specialty	000001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4514	001	0	1	01	01	H4514_001_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H4514	001	0	1	01	01	H4514_001_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H4514	001	0	1	01	01	H4514_001_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4514	001	0	1	01	01	H4514_001_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H4514	004	0	1	01	01	H4514_004_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H4514	004	0	1	01	01	H4514_004_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H4514	004	0	1	01	01	H4514_004_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H4514	004	0	1	01	01	H4514_004_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4514	005	0	1	01	01	H4514_005_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H4514	005	0	1	01	01	H4514_005_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H4514	005	0	1	01	01	H4514_005_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H4514	005	0	1	01	01	H4514_005_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4514	006	0	1	01	01	H4514_006_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H4514	006	0	1	01	01	H4514_006_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H4514	006	0	1	01	01	H4514_006_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H4514	006	0	1	01	01	H4514_006_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4514	007	0	1	01	01	H4514_007_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H4514	007	0	1	01	01	H4514_007_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4514	007	0	1	01	01	H4514_007_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H4514	007	0	1	01	01	H4514_007_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H4520	001	0	1	04	01	H4520_001_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H4520	001	0	1	04	01	H4520_001_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H4520	001	0	1	04	01	H4520_001_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	45.00	135.00								45.00			45.00	112.50									4
H4520	001	0	1	04	01	H4520_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4520	001	0	1	04	01	H4520_001_0	3	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H4520	001	0	1	04	01	H4520_001_0	3	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4520	001	0	1	04	01	H4520_001_0	3	3	3	Other Non-Preferred	100100	1	2	Other Non-Preferred																							Other Non-Preferred					Other Non-Preferred																						Other Non-Preferred																						2	4
H4520	001	0	1	04	01	H4520_001_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4520	002	0	1	04	01	H4520_002_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H4520	002	0	1	04	01	H4520_002_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H4520	002	0	1	04	01	H4520_002_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H4520	002	0	1	04	01	H4520_002_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4520	002	0	1	04	01	H4520_002_0	3	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H4520	002	0	1	04	01	H4520_002_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4520	002	0	1	04	01	H4520_002_0	3	3	3	Other Non-Preferred	100100	1	2	Other Non-Preferred																							Other Non-Preferred					Other Non-Preferred																						Other Non-Preferred																						2	4
H4520	002	0	1	04	01	H4520_002_0	3	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4520	003	0	1	04	01	H4520_003_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4520	003	0	1	04	01	H4520_003_0	3	3	3	Other Non-Preferred	100100	1	2	Other Non-Preferred																							Other Non-Preferred					Other Non-Preferred																						Other Non-Preferred																						2	4
H4520	003	0	1	04	01	H4520_003_0	3	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4520	003	0	1	04	01	H4520_003_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H4520	003	0	1	04	01	H4520_003_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4520	003	0	1	04	01	H4520_003_0	3	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H4520	003	0	1	04	01	H4520_003_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H4520	003	0	1	04	01	H4520_003_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H4520	005	0	1	04	01	H4520_005_0	3	3	3	Other Non-Preferred	100100	1	2	Other Non-Preferred																							Other Non-Preferred					Other Non-Preferred																						Other Non-Preferred																						2	4
H4520	005	0	1	04	01	H4520_005_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4520	005	0	1	04	01	H4520_005_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H4520	005	0	1	04	01	H4520_005_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H4520	005	0	1	04	01	H4520_005_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H4520	005	0	1	04	01	H4520_005_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4520	005	0	1	04	01	H4520_005_0	3	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H4520	005	0	1	04	01	H4520_005_0	3	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4520	006	0	1	04	01	H4520_006_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H4520	006	0	1	04	01	H4520_006_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H4520	006	0	1	04	01	H4520_006_0	3	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4520	006	0	1	04	01	H4520_006_0	3	3	3	Other Non-Preferred	100100	1	2	Other Non-Preferred																							Other Non-Preferred					Other Non-Preferred																						Other Non-Preferred																						2	4
H4520	006	0	1	04	01	H4520_006_0	3	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4520	006	0	1	04	01	H4520_006_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H4520	006	0	1	04	01	H4520_006_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4520	006	0	1	04	01	H4520_006_0	3	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H4521	001	0	1	01	01	H4521_001_0	2	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00									4
H4521	001	0	1	01	01	H4521_001_0	2	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00			90.00									4
H4521	001	0	1	01	01	H4521_001_0	2	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	60.00	180.00								60.00	180.00			180.00									4
H4521	001	0	1	01	01	H4521_001_0	2	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00								1	4
H4521	001	0	1	01	01	H4521_001_0	2	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4521	001	0	1	01	01	H4521_001_0	2	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4521	004	0	1	01	01	H4521_004_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00									3
H4521	004	0	1	01	01	H4521_004_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00			90.00									3
H4521	004	0	1	01	01	H4521_004_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	60.00	180.00								60.00	180.00			180.00									3
H4522	001	0	1	04	01	H4522_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H4522	001	0	1	04	01	H4522_001_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H4522	001	0	1	04	01	H4522_001_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H4522	001	0	1	04	01	H4522_001_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4522	007	0	1	04	01	H4522_007_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H4522	007	0	1	04	01	H4522_007_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H4522	007	0	1	04	01	H4522_007_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H4522	007	0	1	04	01	H4522_007_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4523	001	0	1	01	01	H4523_001_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
H4523	001	0	1	01	01	H4523_001_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
H4523	001	0	1	01	01	H4523_001_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H4523	001	0	1	01	01	H4523_001_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H4523	005	0	1	01	01	H4523_005_0	3	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				11.00	27.50		11.00	33.00		22.00							22.00			33.00			3
H4523	005	0	1	01	01	H4523_005_0	3	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H4523	005	0	1	01	01	H4523_005_0	3	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H4523	006	0	1	01	01	H4523_006_0	3	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H4523	006	0	1	01	01	H4523_006_0	3	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H4523	006	0	1	01	01	H4523_006_0	3	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H4523	006	0	1	01	01	H4523_006_0	3	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H4523	006	0	1	01	01	H4523_006_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H4523	006	0	1	01	01	H4523_006_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H4523	006	0	1	01	01	H4523_006_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H4523	006	0	1	01	01	H4523_006_0	3	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H4523	007	0	1	01	01	H4523_007_0	3	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				11.00	27.50		11.00	33.00		22.00							22.00			33.00			3
H4523	007	0	1	01	01	H4523_007_0	3	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H4523	007	0	1	01	01	H4523_007_0	3	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H4523	009	0	1	01	01	H4523_009_0	4	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H4523	009	0	1	01	01	H4523_009_0	4	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				11.00	27.50		11.00	33.00		22.00							22.00			33.00			3
H4523	009	0	1	01	01	H4523_009_0	4	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H4524	001	0	1	04	01	H4524_001_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H4524	001	0	1	04	01	H4524_001_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H4524	001	0	1	04	01	H4524_001_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H4524	002	0	1	04	01	H4524_002_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H4524	002	0	1	04	01	H4524_002_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H4524	002	0	1	04	01	H4524_002_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H4524	002	0	1	04	01	H4524_002_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H4524	002	0	1	04	01	H4524_002_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H4524	002	0	1	04	01	H4524_002_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H4524	002	0	1	04	01	H4524_002_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H4524	002	0	1	04	01	H4524_002_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H4525	001	0	1	01	01	H4525_001_0	4	2	1	Brand	000010		2	Brand	011000000010011000000	30	90								30			30	90								Brand	2	2		011000000010011000000	Brand																						Brand	30.00	90.00								30.00			30.00	90.00									3
H4525	001	0	1	01	01	H4525_001_0	4	1	1	Generic	010000		2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									3
H4525	002	0	1	01	01	H4525_002_0	4	1	1	Generic	010000		2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									3
H4525	002	0	1	01	01	H4525_002_0	4	2	1	Brand	000010		2	Brand	011000000010011000000	30	90								30			30	90								Brand	2	2		011000000010011000000	Brand																						Brand	30.00	90.00								30.00			30.00	90.00									3
H4525	006	0	1	01	01	H4525_006_0	5	5	1	Specialty	000010	1	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	2		011000000010011000000	Specialty																						Specialty	100.00	300.00								100.00			100.00	300.00									4
H4525	006	0	1	01	01	H4525_006_0	5	1	3	Generic	010000	1	2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00								1	4
H4525	006	0	1	01	01	H4525_006_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4525	006	0	1	01	01	H4525_006_0	5	4	1	Other Brand	000010	1	2	Other Brand	011000000010011000000	30	90								30			30	90								Other Brand	2	2		011000000010011000000	Other Brand																						Other Brand	75.00	225.00								75.00			75.00	225.00									4
H4525	006	0	1	01	01	H4525_006_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H4525	006	0	1	01	01	H4525_006_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	75.00									4
H4525	006	0	1	01	01	H4525_006_0	5	1	1	Generic	010000	1	2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H4525	006	0	1	01	01	H4525_006_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4525	006	0	1	01	01	H4525_006_0	5	5	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4525	006	0	1	01	01	H4525_006_0	5	4	3	Other Brand	000010	1	2	Other Brand																							Other Brand					Other Brand																						Other Brand																						2	4
H4525	007	0	1	01	01	H4525_007_0	5	1	1	Generic	010000	1	2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H4525	007	0	1	01	01	H4525_007_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	75.00									4
H4525	007	0	1	01	01	H4525_007_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H4525	007	0	1	01	01	H4525_007_0	5	4	1	Other Brand	000010	1	2	Other Brand	011000000010011000000	30	90								30			30	90								Other Brand	2	2		011000000010011000000	Other Brand																						Other Brand	75.00	225.00								75.00			75.00	225.00									4
H4525	007	0	1	01	01	H4525_007_0	5	5	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4525	007	0	1	01	01	H4525_007_0	5	1	3	Generic	010000	1	2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00								1	4
H4525	007	0	1	01	01	H4525_007_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4525	007	0	1	01	01	H4525_007_0	5	4	3	Other Brand	000010	1	2	Other Brand																							Other Brand					Other Brand																						Other Brand																						2	4
H4525	007	0	1	01	01	H4525_007_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4525	007	0	1	01	01	H4525_007_0	5	5	1	Specialty	000010	1	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	2		011000000010011000000	Specialty																						Specialty	100.00	300.00								100.00			100.00	300.00									4
H4527	001	0	1	01	01	H4527_001_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H4527	001	0	1	01	01	H4527_001_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
H4527	001	0	1	01	01	H4527_001_0	3	3	1	Non Preferred Generic and Brand	100100	1	2	Non Preferred Generic and Brand	011000000010001000000	30	90								30				90								Non Preferred Generic and Brand	2	2		011000000010001000000	Non Preferred Generic and Brand																						Non Preferred Generic and Brand	50.00	150.00								50.00				150.00									4
H4527	001	0	1	01	01	H4527_001_0	3	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	33									33												Specialty Drugs																							4
H4527	001	0	1	01	01	H4527_001_0	3	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00			0.00	0.00								1	4
H4527	001	0	1	01	01	H4527_001_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	75.00								1	4
H4527	001	0	1	01	01	H4527_001_0	3	3	3	Non Preferred Generic and Brand	100100	1	2	Non Preferred Generic and Brand																							Non Preferred Generic and Brand					Non Preferred Generic and Brand																						Non Preferred Generic and Brand																						2	4
H4527	001	0	1	01	01	H4527_001_0	3	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H4527	002	0	1	01	01	H4527_002_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									3
H4527	002	0	1	01	01	H4527_002_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									3
H4527	002	0	1	01	01	H4527_002_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	20									20												Specialty Drugs																							3
H4527	002	0	1	01	01	H4527_002_0	4	3	1	Non Preferred Generic and Brand	100100		2	Non Preferred Generic and Brand	011000000010001000000	30	90								30				90								Non Preferred Generic and Brand	2	2		011000000010001000000	Non Preferred Generic and Brand																						Non Preferred Generic and Brand	55.00	165.00								55.00				165.00									3
H4527	005	0	1	01	01	H4527_005_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									3
H4527	005	0	1	01	01	H4527_005_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									3
H4527	005	0	1	01	01	H4527_005_0	3	3	1	Non Preferred Generic and Brand	100100		2	Non Preferred Generic and Brand	011000000010001000000	30	90								30				90								Non Preferred Generic and Brand	2	2		011000000010001000000	Non Preferred Generic and Brand																						Non Preferred Generic and Brand	55.00	165.00								55.00				165.00									3
H4527	005	0	1	01	01	H4527_005_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	20									20												Specialty Drugs																							3
H4527	008	0	1	01	01	H4527_008_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									3
H4527	008	0	1	01	01	H4527_008_0	3	3	1	Non Preferred Generic and Brand	100100		2	Non Preferred Generic and Brand	011000000010001000000	30	90								30				90								Non Preferred Generic and Brand	2	2		011000000010001000000	Non Preferred Generic and Brand																						Non Preferred Generic and Brand	55.00	165.00								55.00				165.00									3
H4527	008	0	1	01	01	H4527_008_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									3
H4527	008	0	1	01	01	H4527_008_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	30									30												Specialty Drugs																							3
H4528	001	0	1	01	01	H4528_001_0	8	1	1	Generic	010000		2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
H4528	001	0	1	01	01	H4528_001_0	8	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	26.00	78.00								26.00	78.00		26.00	52.00									3
H4528	001	0	1	01	01	H4528_001_0	8	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	52.00	156.00								52.00	156.00		52.00	104.00									3
H4528	001	0	1	01	01	H4528_001_0	8	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
H4528	005	0	1	01	01	H4528_005_0	9	1	1	Generic	010000		2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
H4528	005	0	1	01	01	H4528_005_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									3
H4528	005	0	1	01	01	H4528_005_0	9	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	62.00	186.00								62.00	186.00		62.00	124.00									3
H4528	005	0	1	01	01	H4528_005_0	9	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
H4529	001	0	1	01	01	H4529_001_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H4529	001	0	1	01	01	H4529_001_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H4529	001	0	1	01	01	H4529_001_0	7	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4529	001	0	1	01	01	H4529_001_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4529	001	0	1	01	01	H4529_001_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4529	001	0	1	01	01	H4529_001_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	24.00	72.00								24.00				48.00								1	4
H4529	001	0	1	01	01	H4529_001_0	7	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4529	001	0	1	01	01	H4529_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				16.00									4
H4529	002	0	1	01	01	H4529_002_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				16.00									4
H4529	002	0	1	01	01	H4529_002_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4529	002	0	1	01	01	H4529_002_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4529	002	0	1	01	01	H4529_002_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	24.00	72.00								24.00				48.00								1	4
H4529	002	0	1	01	01	H4529_002_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4529	002	0	1	01	01	H4529_002_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H4529	002	0	1	01	01	H4529_002_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H4529	002	0	1	01	01	H4529_002_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4529	003	0	1	01	01	H4529_003_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H4529	003	0	1	01	01	H4529_003_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H4529	003	0	1	01	01	H4529_003_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				16.00									4
H4529	003	0	1	01	01	H4529_003_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4529	003	0	1	01	01	H4529_003_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4529	003	0	1	01	01	H4529_003_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4529	003	0	1	01	01	H4529_003_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4529	003	0	1	01	01	H4529_003_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	24.00	72.00								24.00				48.00								1	4
H4529	004	0	1	01	01	H4529_004_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				16.00									4
H4529	004	0	1	01	01	H4529_004_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H4529	004	0	1	01	01	H4529_004_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4529	004	0	1	01	01	H4529_004_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4529	004	0	1	01	01	H4529_004_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4529	004	0	1	01	01	H4529_004_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	24.00	72.00								24.00				48.00								1	4
H4529	004	0	1	01	01	H4529_004_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4529	004	0	1	01	01	H4529_004_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H4529	014	0	1	01	01	H4529_014_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				16.00									4
H4529	014	0	1	01	01	H4529_014_0	8	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4529	014	0	1	01	01	H4529_014_0	8	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	24.00	72.00								24.00				48.00								1	4
H4529	014	0	1	01	01	H4529_014_0	8	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4529	014	0	1	01	01	H4529_014_0	8	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4529	014	0	1	01	01	H4529_014_0	8	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H4529	014	0	1	01	01	H4529_014_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H4529	014	0	1	01	01	H4529_014_0	8	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4529	015	0	1	01	01	H4529_015_0	7	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4529	015	0	1	01	01	H4529_015_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	24.00	72.00								24.00				48.00								1	4
H4529	015	0	1	01	01	H4529_015_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4529	015	0	1	01	01	H4529_015_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4529	015	0	1	01	01	H4529_015_0	7	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4529	015	0	1	01	01	H4529_015_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				16.00									4
H4529	015	0	1	01	01	H4529_015_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H4529	015	0	1	01	01	H4529_015_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H4529	018	0	1	01	01	H4529_018_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				16.00									4
H4529	018	0	1	01	01	H4529_018_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H4529	018	0	1	01	01	H4529_018_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4529	018	0	1	01	01	H4529_018_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4529	018	0	1	01	01	H4529_018_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4529	018	0	1	01	01	H4529_018_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	24.00	72.00								24.00				48.00								1	4
H4529	018	0	1	01	01	H4529_018_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4529	018	0	1	01	01	H4529_018_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H4529	019	0	1	01	01	H4529_019_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	8.00	24.00								8.00				16.00									4
H4529	019	0	1	01	01	H4529_019_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H4529	019	0	1	01	01	H4529_019_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H4529	019	0	1	01	01	H4529_019_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	24.00	72.00								24.00				48.00								1	4
H4529	019	0	1	01	01	H4529_019_0	7	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H4529	019	0	1	01	01	H4529_019_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H4529	019	0	1	01	01	H4529_019_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H4529	019	0	1	01	01	H4529_019_0	7	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H4531	001	0	1	04	01	H4531_001_0	4	1	1	Generic	010000		2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00									3
H4531	001	0	1	04	01	H4531_001_0	4	4	1	Specialty	010010		1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							3
H4531	001	0	1	04	01	H4531_001_0	4	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-preferred Brand	2	2		000011011010001000000	Non-preferred Brand																						Non-preferred Brand				60.00	120.00		60.00	180.00		60.00				120.00									3
H4531	001	0	1	04	01	H4531_001_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				40.00	80.00		40.00	120.00		40.00				80.00									3
H4564	001	0	1	18	06	H4564_001_0	3	3	1	Generics and Brands	010010		2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	50.00	150.00	100.00							50.00			50.00	100.00									3
H4564	001	0	1	18	06	H4564_001_0	3	2	1	Preferred Brands	000001		2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	35.00	105.00	70.00							35.00			35.00	70.00									3
H4564	001	0	1	18	06	H4564_001_0	3	1	1	Preferred Generics	001000		2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	9.00	27.00	18.00							9.00			9.00	18.00									3
H4564	001	0	1	18	06	H4564_001_0	3	4	1	Non-Preferred Brands and Non-Preferred Generics	100100		2	Non-Preferred Brands and Non-Preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-Preferred Brands and Non-Preferred Generics	2	2		011100000010011000000	Non-Preferred Brands and Non-Preferred Generics																						Non-Preferred Brands and Non-Preferred Generics	75.00	225.00	150.00							75.00			75.00	150.00									3
H4564	001	0	1	18	06	H4564_001_0	3	5	1	Specialty	111111		1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							3
H4564	002	0	1	18	06	H4564_002_0	3	3	1	Generics and Brands	010010		2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	50.00	150.00	100.00							50.00			50.00	100.00									3
H4564	002	0	1	18	06	H4564_002_0	3	2	1	Preferred Brands	000001		2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	35.00	105.00	70.00							35.00			35.00	70.00									3
H4564	002	0	1	18	06	H4564_002_0	3	1	1	Preferred Generics	001000		2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	9.00	27.00	18.00							9.00			9.00	18.00									3
H4564	002	0	1	18	06	H4564_002_0	3	5	1	Specialty	111111		1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							3
H4564	002	0	1	18	06	H4564_002_0	3	4	1	Non-Preferred Brands and Non-Preferred Generics	100100		2	Non-Preferred Brands and Non-Preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-Preferred Brands and Non-Preferred Generics	2	2		011100000010011000000	Non-Preferred Brands and Non-Preferred Generics																						Non-Preferred Brands and Non-Preferred Generics	75.00	225.00	150.00							75.00			75.00	150.00									3
H4564	003	0	1	18	06	H4564_003_0	3	5	1	Specialty	111111		1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							3
H4564	003	0	1	18	06	H4564_003_0	3	1	1	Preferred Generics	001000		2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	9.00	27.00	18.00							9.00			9.00	18.00									3
H4564	003	0	1	18	06	H4564_003_0	3	2	1	Preferred Brands	000001		2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	35.00	105.00	70.00							35.00			35.00	70.00									3
H4564	003	0	1	18	06	H4564_003_0	3	3	1	Generics and Brands	010010		2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	50.00	150.00	100.00							50.00			50.00	100.00									3
H4564	003	0	1	18	06	H4564_003_0	3	4	1	Non-Preferred Brands and Non-Preferred Generics	100100		2	Non-Preferred Brands and Non-Preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-Preferred Brands and Non-Preferred Generics	2	2		011100000010011000000	Non-Preferred Brands and Non-Preferred Generics																						Non-Preferred Brands and Non-Preferred Generics	75.00	225.00	150.00							75.00			75.00	150.00									3
H4564	004	0	1	18	06	H4564_004_0	6	3	1	Generics and Brands	010010	1	2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	45.00	135.00	90.00							45.00			45.00	90.00									4
H4564	004	0	1	18	06	H4564_004_0	6	2	1	Preferred Brands	000001	1	2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	25.00	75.00	50.00							25.00			25.00	50.00									4
H4564	004	0	1	18	06	H4564_004_0	6	1	1	Preferred Generics	001000	1	2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	0.00	0.00	0.00							0.00			0.00	0.00									4
H4564	004	0	1	18	06	H4564_004_0	6	4	3	Non-preferred Brands and Non-preferred Generics	100100	1	2	Non-preferred Brands and Non-preferred Generics																							Non-preferred Brands and Non-preferred Generics					Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics																						2	4
H4564	004	0	1	18	06	H4564_004_0	6	4	1	Non-preferred Brands and Non-preferred Generics	100100	1	2	Non-preferred Brands and Non-preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-preferred Brands and Non-preferred Generics	2	2		011100000010011000000	Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics	75.00	225.00	150.00							75.00			75.00	150.00									4
H4564	004	0	1	18	06	H4564_004_0	6	5	1	Specialty	111111	1	1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							4
H4564	004	0	1	18	06	H4564_004_0	6	1	3	Preferred Generics	001000	1	2	Preferred Generics	011100000010011000000	30	60	90							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	8.00	24.00	16.00							8.00			8.00	16.00								1	4
H4564	004	0	1	18	06	H4564_004_0	6	5	3	Specialty	111111	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4564	004	0	1	18	06	H4564_004_0	6	3	3	Generics and Brands	010010	1	2	Generics and Brands																							Generics and Brands					Generics and Brands																						Generics and Brands																						2	4
H4564	004	0	1	18	06	H4564_004_0	6	2	3	Preferred Brands	000001	1	2	Preferred Brands																							Preferred Brands					Preferred Brands																						Preferred Brands																						2	4
H4564	005	0	1	18	06	H4564_005_0	6	5	3	Specialty	111111	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4564	005	0	1	18	06	H4564_005_0	6	4	3	Non-preferred Brands and Non-preferred Generics	100100	1	2	Non-preferred Brands and Non-preferred Generics																							Non-preferred Brands and Non-preferred Generics					Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics																						2	4
H4564	005	0	1	18	06	H4564_005_0	6	3	3	Generics and Brands	010010	1	2	Generics and Brands																							Generics and Brands					Generics and Brands																						Generics and Brands																						2	4
H4564	005	0	1	18	06	H4564_005_0	6	2	3	Preferred Brands	000001	1	2	Preferred Brands																							Preferred Brands					Preferred Brands																						Preferred Brands																						2	4
H4564	005	0	1	18	06	H4564_005_0	6	1	3	Preferred Generics	001000	1	2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	8.00	24.00	16.00							8.00			8.00	16.00								1	4
H4564	005	0	1	18	06	H4564_005_0	6	5	1	Specialty	111111	1	1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							4
H4564	005	0	1	18	06	H4564_005_0	6	2	1	Preferred Brands	000001	1	2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	25.00	75.00	50.00							25.00			25.00	50.00									4
H4564	005	0	1	18	06	H4564_005_0	6	3	1	Generics and Brands	010010	1	2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	45.00	135.00	90.00							45.00			45.00	90.00									4
H4564	005	0	1	18	06	H4564_005_0	6	4	1	Non-preferred Brands and Non-preferred Generics	100100	1	2	Non-preferred Brands and Non-preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-preferred Brands and Non-preferred Generics	2	2		011100000010011000000	Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics	75.00	225.00	150.00							75.00			75.00	150.00									4
H4564	005	0	1	18	06	H4564_005_0	6	1	1	Preferred Generics	001000	1	2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	0.00	0.00	0.00							0.00			0.00	0.00									4
H4564	006	0	1	18	06	H4564_006_0	6	1	1	Preferred Generics	001000	1	2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	0.00	0.00	0.00							0.00			0.00	0.00									4
H4564	006	0	1	18	06	H4564_006_0	6	5	1	Specialty	111111	1	1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							4
H4564	006	0	1	18	06	H4564_006_0	6	1	3	Preferred Generics	001000	1	2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	8.00	24.00	16.00							8.00			8.00	16.00								1	4
H4564	006	0	1	18	06	H4564_006_0	6	2	3	Preferred Brands	000001	1	2	Preferred Brands																							Preferred Brands					Preferred Brands																						Preferred Brands																						2	4
H4564	006	0	1	18	06	H4564_006_0	6	3	3	Generics and Brands	010010	1	2	Generics and Brands																							Generics and Brands					Generics and Brands																						Generics and Brands																						2	4
H4564	006	0	1	18	06	H4564_006_0	6	4	3	Non-preferred Brands and Non-preferred Generics	100100	1	2	Non-preferred Brands and Non-preferred Generics																							Non-preferred Brands and Non-preferred Generics					Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics																						2	4
H4564	006	0	1	18	06	H4564_006_0	6	5	3	Specialty	111111	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4564	006	0	1	18	06	H4564_006_0	6	3	1	Generics and Brands	010010	1	2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	45.00	135.00	90.00							45.00			45.00	90.00									4
H4564	006	0	1	18	06	H4564_006_0	6	2	1	Preferred Brands	000001	1	2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	25.00	75.00	50.00							25.00			25.00	50.00									4
H4564	006	0	1	18	06	H4564_006_0	6	4	1	Non-preferred Brands and Non-preferred Generics	100100	1	2	Non-preferred Brands and Non-preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-preferred Brands and Non-preferred Generics	2	2		011100000010011000000	Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics	75.00	225.00	150.00							75.00			75.00	150.00									4
H4564	013	0	1	18	06	H4564_013_0	6	3	1	Generics and Brands	010010		2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	50.00	150.00	100.00							50.00			50.00	100.00									3
H4564	013	0	1	18	06	H4564_013_0	6	2	1	Preferred Brands	000001		2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	20.00	60.00	40.00							20.00			20.00	40.00									3
H4564	013	0	1	18	06	H4564_013_0	6	1	1	Preferred Generics	001000		2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	5.00	15.00	10.00							5.00			5.00	10.00									3
H4564	013	0	1	18	06	H4564_013_0	6	5	1	Specialty	111111		1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							3
H4564	013	0	1	18	06	H4564_013_0	6	4	1	Non-preferred Brands and Non-preferred Generics	100100		2	Non-preferred Brands and Non-preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-preferred Brands and Non-preferred Generics	2	2		011100000010011000000	Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics	80.00	240.00	160.00							80.00			80.00	160.00									3
H4564	014	0	1	18	06	H4564_014_0	6	4	1	Non-preferred Brands and Non-preferred Generics	100100		2	Non-preferred Brands and Non-preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-preferred Brands and Non-preferred Generics	2	2		011100000010011000000	Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics	80.00	240.00	160.00							80.00			80.00	160.00									3
H4564	014	0	1	18	06	H4564_014_0	6	5	1	Specialty	111111		1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							3
H4564	014	0	1	18	06	H4564_014_0	6	2	1	Preferred Brands	000001		2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	20.00	60.00	40.00							20.00			20.00	40.00									3
H4564	014	0	1	18	06	H4564_014_0	6	1	1	Preferred Generics	001000		2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	5.00	15.00	10.00							5.00			5.00	10.00									3
H4564	014	0	1	18	06	H4564_014_0	6	3	1	Generics and Brands	010010		2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	50.00	150.00	100.00							50.00			50.00	100.00									3
H4564	015	0	1	18	06	H4564_015_0	6	4	1	Non-preferred Brands and Non-preferred Generics	100100		2	Non-preferred Brands and Non-preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-preferred Brands and Non-preferred Generics	2	2		011100000010011000000	Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics	80.00	240.00	160.00							80.00			80.00	160.00									3
H4564	015	0	1	18	06	H4564_015_0	6	1	1	Preferred Generics	001000		2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	5.00	15.00	10.00							5.00			5.00	10.00									3
H4564	015	0	1	18	06	H4564_015_0	6	5	1	Specialty	111111		1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							3
H4564	015	0	1	18	06	H4564_015_0	6	3	1	Generics and Brands	010010		2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	50.00	150.00	100.00							50.00			50.00	100.00									3
H4564	015	0	1	18	06	H4564_015_0	6	2	1	Preferred Brands	000001		2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	20.00	60.00	40.00							20.00			20.00	40.00									3
H4577	005	0	1	09	04	H4577_005_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	005	0	1	09	04	H4577_005_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4577	005	0	1	09	04	H4577_005_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	005	0	1	09	04	H4577_005_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	006	0	1	09	04	H4577_006_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	006	0	1	09	04	H4577_006_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	006	0	1	09	04	H4577_006_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4577	006	0	1	09	04	H4577_006_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	007	0	1	09	04	H4577_007_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	007	0	1	09	04	H4577_007_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	007	0	1	09	04	H4577_007_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	007	0	1	09	04	H4577_007_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4577	008	0	1	09	04	H4577_008_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	008	0	1	09	04	H4577_008_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4577	008	0	1	09	04	H4577_008_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	008	0	1	09	04	H4577_008_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	009	0	1	09	04	H4577_009_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4577	009	0	1	09	04	H4577_009_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	009	0	1	09	04	H4577_009_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	009	0	1	09	04	H4577_009_0	4	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	010	0	1	09	04	H4577_010_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	010	0	1	09	04	H4577_010_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	010	0	1	09	04	H4577_010_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	010	0	1	09	04	H4577_010_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4577	011	0	1	09	04	H4577_011_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	011	0	1	09	04	H4577_011_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	54.00	162.00								54.00	162.00			162.00									4
H4577	011	0	1	09	04	H4577_011_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	64.00	192.00								64.00	192.00			192.00									4
H4577	011	0	1	09	04	H4577_011_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	012	0	1	09	04	H4577_012_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	012	0	1	09	04	H4577_012_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	012	0	1	09	04	H4577_012_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4577	012	0	1	09	04	H4577_012_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	013	0	1	09	04	H4577_013_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	013	0	1	09	04	H4577_013_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	013	0	1	09	04	H4577_013_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	013	0	1	09	04	H4577_013_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4577	014	0	1	09	04	H4577_014_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	014	0	1	09	04	H4577_014_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4577	014	0	1	09	04	H4577_014_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	014	0	1	09	04	H4577_014_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	015	0	1	09	04	H4577_015_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H4577	015	0	1	09	04	H4577_015_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H4577	015	0	1	09	04	H4577_015_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H4577	015	0	1	09	04	H4577_015_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H4590	010	0	1	01	01	H4590_010_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H4590	010	0	1	01	01	H4590_010_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H4590	010	0	1	01	01	H4590_010_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H4590	010	0	1	01	01	H4590_010_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H4590	012	0	1	01	01	H4590_012_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H4590	012	0	1	01	01	H4590_012_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H4590	012	0	1	01	01	H4590_012_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H4590	012	0	1	01	01	H4590_012_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H4590	020	0	1	01	01	H4590_020_0	6	3	1	Tier 3 Non-Preferred	000010		2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			3
H4590	020	0	1	01	01	H4590_020_0	6	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H4590	020	0	1	01	01	H4590_020_0	6	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			3
H4590	020	0	1	01	01	H4590_020_0	6	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H4590	022	0	1	01	01	H4590_022_0	6	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H4590	022	0	1	01	01	H4590_022_0	6	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			3
H4590	022	0	1	01	01	H4590_022_0	6	3	1	Tier 3 Non-Preferred	000010		2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			3
H4590	022	0	1	01	01	H4590_022_0	6	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H4590	025	0	1	01	01	H4590_025_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H4590	025	0	1	01	01	H4590_025_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H4590	025	0	1	01	01	H4590_025_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H4590	025	0	1	01	01	H4590_025_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H4590	028	0	1	01	01	H4590_028_0	8	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4590	028	0	1	01	01	H4590_028_0	8	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H4590	028	0	1	01	01	H4590_028_0	8	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H4590	028	0	1	01	01	H4590_028_0	8	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H4590	028	0	1	01	01	H4590_028_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4590	028	0	1	01	01	H4590_028_0	8	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				56.25	168.75		56.25	168.75		56.25							158.75			168.75			4
H4590	028	0	1	01	01	H4590_028_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H4590	028	0	1	01	01	H4590_028_0	8	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H4590	030	0	1	01	01	H4590_030_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H4590	030	0	1	01	01	H4590_030_0	6	1	3	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00		1	4
H4590	030	0	1	01	01	H4590_030_0	6	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H4590	030	0	1	01	01	H4590_030_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H4590	030	0	1	01	01	H4590_030_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				55.40	166.20		55.40	166.20		55.40							156.20			166.20			4
H4590	030	0	1	01	01	H4590_030_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4590	030	0	1	01	01	H4590_030_0	6	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H4590	030	0	1	01	01	H4590_030_0	6	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4590	031	0	1	01	01	H4590_031_0	6	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H4590	031	0	1	01	01	H4590_031_0	6	3	1	Tier 3 Non-Preferred	000010		2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			3
H4590	031	0	1	01	01	H4590_031_0	6	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			3
H4590	031	0	1	01	01	H4590_031_0	6	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H4590	032	0	1	01	01	H4590_032_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	0.00	0.00								0.00							0.00			0.00			4
H4590	032	0	1	01	01	H4590_032_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H4590	032	0	1	01	01	H4590_032_0	4	3	1	Tier 3 Non-Preferred	000010	1	2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	64.00	192.00								64.00							182.00			192.00			4
H4590	032	0	1	01	01	H4590_032_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4590	033	0	1	01	01	H4590_033_0	6	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H4590	033	0	1	01	01	H4590_033_0	6	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			3
H4590	033	0	1	01	01	H4590_033_0	6	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H4590	033	0	1	01	01	H4590_033_0	6	3	1	Tier 3 Non-Preferred	000010		2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			3
H4590	034	0	1	01	01	H4590_034_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H4590	034	0	1	01	01	H4590_034_0	4	3	1	Tier 3 Non-Preferred	000010		2	Tier 3 Non-Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non-Preferred	2	2		011000000010000001001	Tier 3 Non-Preferred																						Tier 3 Non-Preferred	65.00	195.00								65.00							185.00			195.00			3
H4590	034	0	1	01	01	H4590_034_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			3
H4590	034	0	1	01	01	H4590_034_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H4604	003	0	1	02	01	H4604_003_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4604	003	0	1	02	01	H4604_003_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H4604	003	0	1	02	01	H4604_003_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H4604	003	0	1	02	01	H4604_003_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H4604	006	0	1	02	01	H4604_006_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4604	006	0	1	02	01	H4604_006_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H4604	006	0	1	02	01	H4604_006_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H4604	006	0	1	02	01	H4604_006_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H4604	007	0	1	02	01	H4604_007_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H4604	007	0	1	02	01	H4604_007_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4604	007	0	1	02	01	H4604_007_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H4604	007	0	1	02	01	H4604_007_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H4605	002	0	1	04	01	H4605_002_0	4	1	1	Generic	010000		2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									2
H4605	002	0	1	04	01	H4605_002_0	4	5	1	Miscellaneous Injectable	110001		2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							2
H4605	002	0	1	04	01	H4605_002_0	4	4	1	Specialty	110001		1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							2
H4605	002	0	1	04	01	H4605_002_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	105.00		35.00			35.00			105.00	105.00									2
H4605	002	0	1	04	01	H4605_002_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				18.00	54.00		18.00			18.00			54.00	54.00									2
H4605	004	0	1	04	01	H4605_004_0	4	4	3	Specialty Medications	110001	1	1	Specialty Medications																							Specialty Medications					Specialty Medications																						Specialty Medications																						2	4
H4605	004	0	1	04	01	H4605_004_0	4	5	3	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables																							Miscellaneous Injectables					Miscellaneous Injectables																						Miscellaneous Injectables																						2	4
H4605	004	0	1	04	01	H4605_004_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4605	004	0	1	04	01	H4605_004_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4605	004	0	1	04	01	H4605_004_0	4	1	3	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00								1	4
H4605	004	0	1	04	01	H4605_004_0	4	5	1	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables	000010010010010000000				30			30			30			30									Miscellaneous Injectables	2	1	000010010010010000000		Miscellaneous Injectables				25			25			25			25									Miscellaneous Injectables																							4
H4605	004	0	1	04	01	H4605_004_0	4	4	1	Specialty Medications	110001	1	1	Specialty Medications	000010010010010000000				30			30			30			30									Specialty Medications	2	1	000010010010010000000		Specialty Medications				25			25			25			25									Specialty Medications																							4
H4605	004	0	1	04	01	H4605_004_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	150.00		50.00			50.00			150.00	150.00									4
H4605	004	0	1	04	01	H4605_004_0	4	1	1	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									4
H4605	004	0	1	04	01	H4605_004_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00			25.00			75.00	75.00									4
H4606	004	0	1	04	01	H4606_004_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H4606	004	0	1	04	01	H4606_004_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H4606	004	0	1	04	01	H4606_004_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
H4606	004	0	1	04	01	H4606_004_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H4606	004	0	1	04	01	H4606_004_0	4	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00								1	4
H4606	004	0	1	04	01	H4606_004_0	4	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4606	004	0	1	04	01	H4606_004_0	4	3	3	Other Non-Preferred	100100	1	2	Other Non-Preferred																							Other Non-Preferred					Other Non-Preferred																						Other Non-Preferred																						2	4
H4606	004	0	1	04	01	H4606_004_0	4	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H4720	001	0	1	09	04	H4720_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H4720	001	0	1	09	04	H4720_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H4720	001	0	1	09	04	H4720_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H4720	001	0	1	09	04	H4720_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4779	001	0	1	37	05	H4779_001_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H4779	001	0	1	37	05	H4779_001_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H4779	001	0	1	37	05	H4779_001_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4779	001	0	1	37	05	H4779_001_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H4779	003	0	1	37	05	H4779_003_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H4779	003	0	1	37	05	H4779_003_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H4779	003	0	1	37	05	H4779_003_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H4779	003	0	1	37	05	H4779_003_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H4908	002	0	1	04	01	H4908_002_0	5	4	1	Specialty	010010		1	Specialty	011000000011001000000	31	90								31	90			90								Specialty	1	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							3
H4908	002	0	1	04	01	H4908_002_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	65.00	195.00								65.00	195.00			195.00									3
H4908	002	0	1	04	01	H4908_002_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	31	90								31	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									3
H4908	002	0	1	04	01	H4908_002_0	5	1	1	Generic	010000		2	Generic	011000000011001000000	31	90								31	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	7.00	21.00								7.00	21.00			21.00									3
H4908	004	0	1	04	01	H4908_004_0	4	4	1	Specialty	010010		1	Specialty	011000000011001000000	31	90								31	90			90								Specialty	1	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							3
H4908	004	0	1	04	01	H4908_004_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	65.00	195.00								65.00	195.00			195.00									3
H4908	004	0	1	04	01	H4908_004_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	31	90								31	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00	120.00			120.00									3
H4908	004	0	1	04	01	H4908_004_0	4	1	1	Generic	010000		2	Generic	011000000011001000000	31	90								31	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	7.00	21.00								7.00	21.00			21.00									3
H4909	001	0	1	04	01	H4909_001_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H4909	001	0	1	04	01	H4909_001_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H4909	001	0	1	04	01	H4909_001_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H4909	001	0	1	04	01	H4909_001_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H4909	001	0	1	04	01	H4909_001_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H4909	004	0	1	04	01	H4909_004_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H4909	004	0	1	04	01	H4909_004_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00		1	4
H4909	004	0	1	04	01	H4909_004_0	7	5	3	Speciality Injectables	010010	1	1	Speciality Injectables																							Speciality Injectables					Speciality Injectables																						Speciality Injectables																						2	4
H4909	004	0	1	04	01	H4909_004_0	7	5	1	Speciality Injectables	010010	1	1	Speciality Injectables	011000000010000001001	30	90								30							90			90		Speciality Injectables	2	1	011000000010000001001		Speciality Injectables	30	30								30							25			25		Speciality Injectables																							4
H4909	004	0	1	04	01	H4909_004_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H4909	004	0	1	04	01	H4909_004_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H4909	004	0	1	04	01	H4909_004_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H4909	004	0	1	04	01	H4909_004_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00			4
H4909	004	0	1	04	01	H4909_004_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H4909	004	0	1	04	01	H4909_004_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			4
H4910	002	0	1	01	01	H4910_002_0	5	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H4910	002	0	1	01	01	H4910_002_0	5	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H4910	002	0	1	01	01	H4910_002_0	5	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H4910	002	0	1	01	01	H4910_002_0	5	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H4910	002	0	1	01	01	H4910_002_0	5	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H4910	002	0	1	01	01	H4910_002_0	5	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H4910	002	0	1	01	01	H4910_002_0	5	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H4910	002	0	1	01	01	H4910_002_0	5	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H4910	004	0	1	01	01	H4910_004_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H4910	004	0	1	01	01	H4910_004_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H4910	004	0	1	01	01	H4910_004_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				11.00	27.50		11.00	33.00		22.00							22.00			33.00			3
H4911	002	0	1	04	01	H4911_002_0	5	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H4911	002	0	1	04	01	H4911_002_0	5	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H4911	002	0	1	04	01	H4911_002_0	5	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H4911	002	0	1	04	01	H4911_002_0	5	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H4911	002	0	1	04	01	H4911_002_0	5	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H4911	002	0	1	04	01	H4911_002_0	5	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H4911	002	0	1	04	01	H4911_002_0	5	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H4911	002	0	1	04	01	H4911_002_0	5	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H4911	003	0	1	04	01	H4911_003_0	4	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H4911	003	0	1	04	01	H4911_003_0	4	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H4911	003	0	1	04	01	H4911_003_0	4	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H5005	001	0	1	01	01	H5005_001_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H5005	001	0	1	01	01	H5005_001_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H5005	001	0	1	01	01	H5005_001_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H5005	001	0	1	01	01	H5005_001_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H5005	010	0	1	01	01	H5005_010_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H5005	010	0	1	01	01	H5005_010_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H5005	010	0	1	01	01	H5005_010_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H5005	010	0	1	01	01	H5005_010_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H5005	011	0	1	01	01	H5005_011_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H5005	011	0	1	01	01	H5005_011_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H5005	011	0	1	01	01	H5005_011_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H5005	011	0	1	01	01	H5005_011_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H5005	013	0	1	01	01	H5005_013_0	5	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H5005	013	0	1	01	01	H5005_013_0	5	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H5005	013	0	1	01	01	H5005_013_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H5005	013	0	1	01	01	H5005_013_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H5005	019	0	1	01	01	H5005_019_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H5005	019	0	1	01	01	H5005_019_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H5005	019	0	1	01	01	H5005_019_0	7	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H5005	019	0	1	01	01	H5005_019_0	7	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H5005	020	0	1	01	01	H5005_020_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H5005	020	0	1	01	01	H5005_020_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H5005	020	0	1	01	01	H5005_020_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H5005	020	0	1	01	01	H5005_020_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H5005	022	0	1	01	01	H5005_022_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H5005	022	0	1	01	01	H5005_022_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H5005	022	0	1	01	01	H5005_022_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H5005	022	0	1	01	01	H5005_022_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H5006	010	0	1	09	04	H5006_010_0	10	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
H5006	010	0	1	09	04	H5006_010_0	10	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00										40.00		80.00									4
H5006	010	0	1	09	04	H5006_010_0	10	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	90.00										30.00		60.00									4
H5006	010	0	1	09	04	H5006_010_0	10	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									4
H5008	001	0	1	01	01	H5008_001_0	5	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H5008	001	0	1	01	01	H5008_001_0	5	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H5008	001	0	1	01	01	H5008_001_0	5	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H5008	001	0	1	01	01	H5008_001_0	5	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H5008	002	0	1	01	01	H5008_002_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H5008	002	0	1	01	01	H5008_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H5008	002	0	1	01	01	H5008_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H5008	002	0	1	01	01	H5008_002_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5009	002	0	1	04	01	H5009_002_0	4	4	1	Specialty	110001		1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							2
H5009	002	0	1	04	01	H5009_002_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	105.00		35.00			35.00			105.00	105.00									2
H5009	002	0	1	04	01	H5009_002_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				18.00	54.00		18.00			18.00			54.00	54.00									2
H5009	002	0	1	04	01	H5009_002_0	4	5	1	Miscellaneous Injectable	110001		2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							2
H5009	002	0	1	04	01	H5009_002_0	4	1	1	Generic	010000		2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									2
H5009	004	0	1	04	01	H5009_004_0	4	1	3	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00								1	4
H5009	004	0	1	04	01	H5009_004_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5009	004	0	1	04	01	H5009_004_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5009	004	0	1	04	01	H5009_004_0	4	4	3	Specialty Medications	110001	1	1	Specialty Medications																							Specialty Medications					Specialty Medications																						Specialty Medications																						2	4
H5009	004	0	1	04	01	H5009_004_0	4	5	3	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables																							Miscellaneous Injectables					Miscellaneous Injectables																						Miscellaneous Injectables																						2	4
H5009	004	0	1	04	01	H5009_004_0	4	1	1	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									4
H5009	004	0	1	04	01	H5009_004_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00			25.00			75.00	75.00									4
H5009	004	0	1	04	01	H5009_004_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	150.00		50.00			50.00			150.00	150.00									4
H5009	004	0	1	04	01	H5009_004_0	4	4	1	Specialty Medications	110001	1	1	Specialty Medications	000010010010010000000				30			30			30			30									Specialty Medications	2	1	000010010010010000000		Specialty Medications				25			25			25			25									Specialty Medications																							4
H5009	004	0	1	04	01	H5009_004_0	4	5	1	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables	000010010010010000000				30			30			30			30									Miscellaneous Injectables	2	1	000010010010010000000		Miscellaneous Injectables				25			25			25			25									Miscellaneous Injectables																							4
H5010	002	0	1	04	01	H5010_002_0	4	1	1	Generic	010000		2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									2
H5010	002	0	1	04	01	H5010_002_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				18.00	54.00		18.00			18.00			54.00	54.00									2
H5010	002	0	1	04	01	H5010_002_0	4	5	1	Miscellaneous Injectable	110001		2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							2
H5010	002	0	1	04	01	H5010_002_0	4	4	1	Specialty	110001		1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							2
H5010	002	0	1	04	01	H5010_002_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	105.00		35.00			35.00			105.00	105.00									2
H5010	004	0	1	04	01	H5010_004_0	4	5	3	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables																							Miscellaneous Injectables					Miscellaneous Injectables																						Miscellaneous Injectables																						2	4
H5010	004	0	1	04	01	H5010_004_0	4	1	3	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00								1	4
H5010	004	0	1	04	01	H5010_004_0	4	5	1	Miscellaneous Injectables	110001	1	2	Miscellaneous Injectables	000010010010010000000				30			30			30			30									Miscellaneous Injectables	2	1	000010010010010000000		Miscellaneous Injectables				25			25			25			25									Miscellaneous Injectables																							4
H5010	004	0	1	04	01	H5010_004_0	4	4	1	Specialty Medications	110001	1	1	Specialty Medications	000010010010010000000				30			30			30			30									Specialty Medications	2	1	000010010010010000000		Specialty Medications				25			25			25			25									Specialty Medications																							4
H5010	004	0	1	04	01	H5010_004_0	4	1	1	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									4
H5010	004	0	1	04	01	H5010_004_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00			25.00			75.00	75.00									4
H5010	004	0	1	04	01	H5010_004_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5010	004	0	1	04	01	H5010_004_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5010	004	0	1	04	01	H5010_004_0	4	4	3	Specialty Medications	110001	1	1	Specialty Medications																							Specialty Medications					Specialty Medications																						Specialty Medications																						2	4
H5010	004	0	1	04	01	H5010_004_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	150.00		50.00			50.00			150.00	150.00									4
H5050	004	0	1	01	01	H5050_004_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011011000000	30	90								30	90		30	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00	30.00		10.00	30.00									4
H5050	004	0	1	01	01	H5050_004_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00	45.00		15.00	45.00									4
H5050	004	0	1	01	01	H5050_004_0	5	3	1	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand	011000000011011000000	30	90								30	90		30	90								Non-Preferred Generic/Brand	2	1	011000000011011000000		Non-Preferred Generic/Brand	50	50								50	50		50	50								Non-Preferred Generic/Brand																							4
H5050	009	0	1	01	01	H5050_009_0	5	3	1	Non-Preferred Generic/Brand	100100		2	Non-Preferred Generic/Brand	011000000011011000000	30	90								30	90		30	90								Non-Preferred Generic/Brand	2	1	011000000011011000000		Non-Preferred Generic/Brand	50	50								50	50		50	50								Non-Preferred Generic/Brand																							2
H5050	009	0	1	01	01	H5050_009_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	1	011000000011011000000		Preferred Brand	25	25								25	25		25	25								Preferred Brand																							2
H5050	009	0	1	01	01	H5050_009_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	30	90								30	90		30	90								Preferred Generic	2	1	011000000011011000000		Preferred Generic	15	15								15	15		15	15								Preferred Generic																							2
H5050	010	0	1	01	01	H5050_010_0	6	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	30	90								30	90		30	90								Preferred Generic	2	1	011000000011011000000		Preferred Generic	15	15								15	15		15	15								Preferred Generic																							2
H5050	010	0	1	01	01	H5050_010_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	1	011000000011011000000		Preferred Brand	25	25								25	25		25	25								Preferred Brand																							2
H5050	010	0	1	01	01	H5050_010_0	6	3	1	Non-Preferred Generic/Brand	100100		2	Non-Preferred Generic/Brand	011000000011011000000	30	90								30	90		30	90								Non-Preferred Generic/Brand	2	1	011000000011011000000		Non-Preferred Generic/Brand	50	50								50	50		50	50								Non-Preferred Generic/Brand																							2
H5106	013	0	1	04	01	H5106_013_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	53.00	132.50								53.00				132.50									3
H5106	013	0	1	04	01	H5106_013_0	6	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	8.00	20.00								8.00				20.00									3
H5106	013	0	1	04	01	H5106_013_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				65.00									3
H5106	014	0	1	04	01	H5106_014_0	13	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				65.00									4
H5106	014	0	1	04	01	H5106_014_0	13	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	8.00	20.00								8.00				20.00									4
H5106	014	0	1	04	01	H5106_014_0	13	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	53.00	132.50								53.00				132.50									4
H5106	014	0	1	04	01	H5106_014_0	13	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5106	014	0	1	04	01	H5106_014_0	13	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5106	014	0	1	04	01	H5106_014_0	13	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	8.00	20.00								8.00				20.00								1	4
H5106	015	0	1	04	01	H5106_015_0	6	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	8.00	20.00								8.00				20.00									3
H5106	015	0	1	04	01	H5106_015_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				65.00									3
H5106	015	0	1	04	01	H5106_015_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	53.00	132.50								53.00				132.50									3
H5106	016	0	1	04	01	H5106_016_0	12	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	8.00	20.00								8.00				20.00								1	4
H5106	016	0	1	04	01	H5106_016_0	12	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	53.00	132.50								53.00				132.50									4
H5106	016	0	1	04	01	H5106_016_0	12	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				65.00									4
H5106	016	0	1	04	01	H5106_016_0	12	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	8.00	20.00								8.00				20.00									4
H5106	016	0	1	04	01	H5106_016_0	12	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5106	016	0	1	04	01	H5106_016_0	12	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5151	002	0	1	01	01	H5151_002_0	8	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	9.00	27.00								9.00	27.00			18.00									4
H5151	002	0	1	01	01	H5151_002_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00	105.00			70.00									4
H5151	002	0	1	01	01	H5151_002_0	8	4	3	Specialty	010001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5151	002	0	1	01	01	H5151_002_0	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5151	002	0	1	01	01	H5151_002_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5151	002	0	1	01	01	H5151_002_0	8	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	15.00	45.00								15.00	45.00			30.00								1	4
H5151	002	0	1	01	01	H5151_002_0	8	4	1	Specialty	010001	1	1	Specialty	011000000011010000000	30	90								30	90		30									Specialty	1	1	011000000011010000000		Specialty	20	20								20	20		20									Specialty																							4
H5151	002	0	1	01	01	H5151_002_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	1	011000000011001000000		Non-Preferred Brand	50	50								50	50			50								Non-Preferred Brand																							4
H5151	003	0	1	01	01	H5151_003_0	8	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	9.00	27.00								9.00	27.00			18.00									4
H5151	003	0	1	01	01	H5151_003_0	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5151	003	0	1	01	01	H5151_003_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5151	003	0	1	01	01	H5151_003_0	8	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	15.00	45.00								15.00	45.00			30.00								1	4
H5151	003	0	1	01	01	H5151_003_0	8	4	1	Specialty	010001	1	1	Specialty	011000000011010000000	30	90								30	90		30									Specialty	1	1	011000000011010000000		Specialty	20	20								20	20		20									Specialty																							4
H5151	003	0	1	01	01	H5151_003_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	1	011000000011001000000		Non-Preferred Brand	50	50								50	50			50								Non-Preferred Brand																							4
H5151	003	0	1	01	01	H5151_003_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00	105.00			70.00									4
H5151	003	0	1	01	01	H5151_003_0	8	4	3	Specialty	010001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5211	002	0	1	01	01	H5211_002_0	5	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				15.00									3
H5211	002	0	1	01	01	H5211_002_0	5	2	1	Tier 2	000001		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				75.00									3
H5211	002	0	1	01	01	H5211_002_0	5	3	1	Tier 3	100000		2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	60.00	180.00								60.00				180.00									3
H5211	002	0	1	01	01	H5211_002_0	5	4	1	Tier 4	000001		1	Tier 4	010000000010010000000	30									30			30									Tier 4	2	1	010000000010010000000		Tier 4	33									33			33									Tier 4																							3
H5211	004	0	1	02	01	H5211_004_0	4	4	1	Tier 4	000001		1	Tier 4	010000000010010000000	30									30			30									Tier 4	2	1	010000000010010000000		Tier 4	33									33			33									Tier 4																							3
H5211	004	0	1	02	01	H5211_004_0	4	3	1	Tier 3	100000		2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	60.00	180.00								60.00				180.00									3
H5211	004	0	1	02	01	H5211_004_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	75.00								25.00				75.00									3
H5211	004	0	1	02	01	H5211_004_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				15.00									3
H5214	003	0	1	04	01	H5214_003_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H5214	003	0	1	04	01	H5214_003_0	3	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H5214	003	0	1	04	01	H5214_003_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H5214	003	0	1	04	01	H5214_003_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									4
H5215	002	0	1	04	01	H5215_002_0	9	4	1	Specialty Products	001001	1	1	Specialty Products	000010010010000000000				31			31			31												Specialty Products	2	1	000010010010000000000		Specialty Products				25			33			33												Specialty Products																							4
H5215	002	0	1	04	01	H5215_002_0	9	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Formulary Non-Preferred Brand	2	2		011000000010011000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	48.00	144.00								48.00			48.00	144.00									4
H5215	002	0	1	04	01	H5215_002_0	9	2	1	Formulary Preferred Brand	010001	1	2	Formulary Preferred Brand	011000000010011000000	31	90								31			31	90								Formulary Preferred Brand	1	2		011000000010011000000	Formulary Preferred Brand																						Formulary Preferred Brand	24.00	62.50								24.00			24.00	62.50									4
H5215	002	0	1	04	01	H5215_002_0	9	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000010011000000	31	90								31			31	90								Formulary Generic	2	2		011000000010011000000	Formulary Generic																						Formulary Generic	8.00	22.00								8.00			8.00	22.00									4
H5215	005	0	1	04	01	H5215_005_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
H5215	005	0	1	04	01	H5215_005_0	10	4	3	Specialty Products	001001	1	1	Specialty Products																							Specialty Products					Specialty Products																						Specialty Products																						2	4
H5215	005	0	1	04	01	H5215_005_0	10	2	3	Formulary Preferred Brand	010001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5215	005	0	1	04	01	H5215_005_0	10	1	3	Formulary Generic	001000	1	2	Formulary Generic	011000000010011000000	31	90								31			31	90								Formulary Generic	2	2		011000000010011000000	Formulary Generic																						Formulary Generic	8.00	22.00								8.00			8.00	22.00								1	4
H5215	005	0	1	04	01	H5215_005_0	10	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000010011000000	31	90								31			31	90								Formulary Generic	2	2		011000000010011000000	Formulary Generic																						Formulary Generic	8.00	22.00								8.00			8.00	22.00									4
H5215	005	0	1	04	01	H5215_005_0	10	2	1	Formulary Preferred Brand	010001	1	2	Formulary Preferred Brand	011000000010011000000	31	90								31			31	90								Formulary Preferred Brand	1	2		011000000010011000000	Formulary Preferred Brand																						Formulary Preferred Brand	24.00	62.50								24.00			24.00	62.50									4
H5215	005	0	1	04	01	H5215_005_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Formulary Non-Preferred Brand	2	2		011000000010011000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	48.00	144.00								48.00			48.00	144.00									4
H5215	005	0	1	04	01	H5215_005_0	10	4	1	Specialty Products	001001	1	1	Specialty Products	000010010010000000000				31			31			31												Specialty Products	2	1	000010010010000000000		Specialty Products				25			33			33												Specialty Products																							4
H5216	001	0	1	04	01	H5216_001_0	6	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00			10.00	25.00									4
H5216	001	0	1	04	01	H5216_001_0	6	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H5216	001	0	1	04	01	H5216_001_0	6	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	55.00	165.00								55.00			55.00	137.50									4
H5216	001	0	1	04	01	H5216_001_0	6	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H5227	001	0	1	09	04	H5227_001_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5227	001	0	1	09	04	H5227_001_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
H5227	001	0	1	09	04	H5227_001_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5227	001	0	1	09	04	H5227_001_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
H5227	001	0	1	09	04	H5227_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5227	001	0	1	09	04	H5227_001_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00								1	4
H5227	001	0	1	09	04	H5227_001_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5227	001	0	1	09	04	H5227_001_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H5253	004	0	1	02	01	H5253_004_0	10	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H5253	004	0	1	02	01	H5253_004_0	10	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5253	004	0	1	02	01	H5253_004_0	10	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H5253	004	0	1	02	01	H5253_004_0	10	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5253	007	0	1	01	01	H5253_007_0	5	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H5253	007	0	1	01	01	H5253_007_0	5	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H5253	007	0	1	01	01	H5253_007_0	5	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H5253	007	0	1	01	01	H5253_007_0	5	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H5253	011	0	1	02	01	H5253_011_0	11	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5253	011	0	1	02	01	H5253_011_0	11	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H5253	011	0	1	02	01	H5253_011_0	11	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5253	011	0	1	02	01	H5253_011_0	11	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H5253	024	0	1	01	01	H5253_024_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H5253	024	0	1	01	01	H5253_024_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H5253	024	0	1	01	01	H5253_024_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5253	024	0	1	01	01	H5253_024_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H5262	001	0	1	01	01	H5262_001_0	2	1	1	Tier 1 - Generic Drugs	010000		2	Tier 1 - Generic Drugs	011000000010000000000	30	90								30												Tier 1 - Generic Drugs	2	2		011000000010000000000	Tier 1 - Generic Drugs																						Tier 1 - Generic Drugs	6.00	18.00								6.00													3
H5262	001	0	1	01	01	H5262_001_0	2	2	1	Tier 2 - Formulary Preferred Brand Drugs	000001		2	Tier 2 - Formulary Preferred Brand Drugs	011000000010000000000	30	90								30												Tier 2 - Formulary Preferred Brand Drugs	2	2		011000000010000000000	Tier 2 - Formulary Preferred Brand Drugs																						Tier 2 - Formulary Preferred Brand Drugs	26.00	78.00								26.00													3
H5262	001	0	1	01	01	H5262_001_0	2	3	1	Tier 3 - Formulary Non-Preferred Brand Drug	100000		2	Tier 3 - Formulary Non-Preferred Brand Drug	011000000010000000000	30	90								30												Tier 3 - Formulary Non-Preferred Brand Drug	2	2		011000000010000000000	Tier 3 - Formulary Non-Preferred Brand Drug																						Tier 3 - Formulary Non-Preferred Brand Drug	50.00	150.00								50.00													3
H5262	001	0	1	01	01	H5262_001_0	2	4	1	Tier 4 - Specialty High Cost Drugs	010010		1	Tier 4 - Specialty High Cost Drugs	010000000010000000000	30									30												Tier 4 - Specialty High Cost Drugs	2	1	010000000010000000000		Tier 4 - Specialty High Cost Drugs	33									33												Tier 4 - Specialty High Cost Drugs																							3
H5262	003	0	1	01	01	H5262_003_0	2	3	1	Tier 3 - Formulary Non-Preferred Brand Drug	100000		2	Tier 3 - Formulary Non-Preferred Brand Drug	011000000010000000000	30	90								30												Tier 3 - Formulary Non-Preferred Brand Drug	2	2		011000000010000000000	Tier 3 - Formulary Non-Preferred Brand Drug																						Tier 3 - Formulary Non-Preferred Brand Drug	50.00	150.00								50.00													3
H5262	003	0	1	01	01	H5262_003_0	2	2	1	Tier 2 - Formulary Preferred Brand Drugs	000001		2	Tier 2 - Formulary Preferred Brand Drugs	011000000010000000000	30	90								30												Tier 2 - Formulary Preferred Brand Drugs	2	2		011000000010000000000	Tier 2 - Formulary Preferred Brand Drugs																						Tier 2 - Formulary Preferred Brand Drugs	26.00	78.00								26.00													3
H5262	003	0	1	01	01	H5262_003_0	2	1	1	Tier 1 - Generic Drugs	010000		2	Tier 1 - Generic Drugs	011000000010000000000	30	90								30												Tier 1 - Generic Drugs	2	2		011000000010000000000	Tier 1 - Generic Drugs																						Tier 1 - Generic Drugs	6.00	18.00								6.00													3
H5262	003	0	1	01	01	H5262_003_0	2	4	1	Tier 4 - Specialty High Cost Drugs	010010		1	Tier 4 - Specialty High Cost Drugs	010000000010000000000	30									30												Tier 4 - Specialty High Cost Drugs	2	1	010000000010000000000		Tier 4 - Specialty High Cost Drugs	33									33												Tier 4 - Specialty High Cost Drugs																							3
H5302	003	0	1	02	01	H5302_003_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	24.00	72.00								24.00				48.00									3
H5302	003	0	1	02	01	H5302_003_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									3
H5302	003	0	1	02	01	H5302_003_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00				110.00									3
H5302	003	0	1	02	01	H5302_003_0	3	4	1	Specialty Drugs	000010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
H5302	004	0	1	02	01	H5302_004_0	7	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	54.00	162.00								54.00				108.00									4
H5302	004	0	1	02	01	H5302_004_0	7	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5302	004	0	1	02	01	H5302_004_0	7	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H5302	004	0	1	02	01	H5302_004_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5302	004	0	1	02	01	H5302_004_0	7	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H5302	004	0	1	02	01	H5302_004_0	7	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H5302	004	0	1	02	01	H5302_004_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5302	004	0	1	02	01	H5302_004_0	7	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5304	001	0	1	09	04	H5304_001_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5304	001	0	1	09	04	H5304_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H5304	001	0	1	09	04	H5304_001_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H5304	001	0	1	09	04	H5304_001_0	6	4	1	Non-Speciality Injectables	010010	1	2	Non-Speciality Injectables	011000000010000001001	30	90								30							90			90		Non-Speciality Injectables	2	1	011000000010000001001		Non-Speciality Injectables	30	30								30							25			25		Non-Speciality Injectables																							4
H5304	001	0	1	09	04	H5304_001_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5402	007	0	1	01	01	H5402_007_0	5	4	3	Tier 4	100100	1	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5402	007	0	1	01	01	H5402_007_0	5	3	3	Tier 3	000110	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5402	007	0	1	01	01	H5402_007_0	5	5	3	Tier 5	010010	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
H5402	007	0	1	01	01	H5402_007_0	5	1	1	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00									4
H5402	007	0	1	01	01	H5402_007_0	5	2	3	Tier 2	010001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5402	007	0	1	01	01	H5402_007_0	5	3	1	Tier 3	000110	3	2	Tier 3	010000000010010000000	30									30			30									Tier 3	2	2		010000000010010000000	Tier 3																						Tier 3	68.00									68.00			68.00										4
H5402	007	0	1	01	01	H5402_007_0	5	4	1	Tier 4	100100	1	2	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							4
H5402	007	0	1	01	01	H5402_007_0	5	5	1	Tier 5	010010	1	1	Tier 5	010000000000100000000	30											7										Tier 5	1	1	010000000000100000000		Tier 5	33											33										Tier 5																							4
H5402	007	0	1	01	01	H5402_007_0	5	1	3	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00								1	4
H5402	007	0	1	01	01	H5402_007_0	5	2	1	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00									4
H5402	010	0	1	01	01	H5402_010_0	6	3	1	Tier 3	000110	3	2	Tier 3	010000000010010000000	30									30			30									Tier 3	2	2		010000000010010000000	Tier 3																						Tier 3	68.00									68.00			68.00										4
H5402	010	0	1	01	01	H5402_010_0	6	1	1	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00									4
H5402	010	0	1	01	01	H5402_010_0	6	2	1	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00									4
H5402	010	0	1	01	01	H5402_010_0	6	5	3	Tier 5	010010	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
H5402	010	0	1	01	01	H5402_010_0	6	4	3	Tier 4	100100	1	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5402	010	0	1	01	01	H5402_010_0	6	3	3	Tier 3	000110	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5402	010	0	1	01	01	H5402_010_0	6	2	3	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00								1	4
H5402	010	0	1	01	01	H5402_010_0	6	4	1	Tier 4	100100	1	2	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							4
H5402	010	0	1	01	01	H5402_010_0	6	5	1	Tier 5	010010	1	1	Tier 5	010000000000100000000	30											7										Tier 5	1	1	010000000000100000000		Tier 5	33											33										Tier 5																							4
H5402	010	0	1	01	01	H5402_010_0	6	1	3	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00								1	4
H5402	011	0	1	01	01	H5402_011_0	5	1	1	Tier 1	001001		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00									3
H5402	011	0	1	01	01	H5402_011_0	5	4	1	Tier 4	100100		2	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							3
H5402	011	0	1	01	01	H5402_011_0	5	3	1	Tier 3	000110		2	Tier 3	010000000010010000000	30									30			30									Tier 3	2	2		010000000010010000000	Tier 3																						Tier 3	68.00									68.00			68.00										3
H5402	011	0	1	01	01	H5402_011_0	5	2	1	Tier 2	010001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00									3
H5402	011	0	1	01	01	H5402_011_0	5	5	1	Tier 5	010010		1	Tier 5	010000000000100000000	30											7										Tier 5	1	1	010000000000100000000		Tier 5	33											33										Tier 5																							3
H5402	012	0	1	01	01	H5402_012_0	4	4	1	Tier 4	100100	1	2	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							4
H5402	012	0	1	01	01	H5402_012_0	4	5	1	Tier 5	010010	1	1	Tier 5	010000000000100000000	30											7										Tier 5	1	1	010000000000100000000		Tier 5	33											33										Tier 5																							4
H5402	012	0	1	01	01	H5402_012_0	4	1	3	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00								1	4
H5402	012	0	1	01	01	H5402_012_0	4	2	3	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00								1	4
H5402	012	0	1	01	01	H5402_012_0	4	3	3	Tier 3	000110	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5402	012	0	1	01	01	H5402_012_0	4	4	3	Tier 4	100100	1	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5402	012	0	1	01	01	H5402_012_0	4	5	3	Tier 5	010010	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
H5402	012	0	1	01	01	H5402_012_0	4	1	1	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00									4
H5402	012	0	1	01	01	H5402_012_0	4	2	1	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00									4
H5402	012	0	1	01	01	H5402_012_0	4	3	1	Tier 3	000110	3	2	Tier 3	010000000010010000000	30									30			30									Tier 3	2	2		010000000010010000000	Tier 3																						Tier 3	68.00									68.00			68.00										4
H5402	013	0	1	01	01	H5402_013_0	4	4	1	Tier 4	100100	1	2	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							4
H5402	013	0	1	01	01	H5402_013_0	4	3	1	Tier 3	000110	3	2	Tier 3	010000000010010000000	30									30			30									Tier 3	2	2		010000000010010000000	Tier 3																						Tier 3	68.00									68.00			68.00										4
H5402	013	0	1	01	01	H5402_013_0	4	2	1	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00									4
H5402	013	0	1	01	01	H5402_013_0	4	1	1	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00									4
H5402	013	0	1	01	01	H5402_013_0	4	5	3	Tier 5	010010	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
H5402	013	0	1	01	01	H5402_013_0	4	1	3	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00								1	4
H5402	013	0	1	01	01	H5402_013_0	4	2	3	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00								1	4
H5402	013	0	1	01	01	H5402_013_0	4	3	3	Tier 3	000110	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5402	013	0	1	01	01	H5402_013_0	4	4	3	Tier 4	100100	1	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5402	013	0	1	01	01	H5402_013_0	4	5	1	Tier 5	010010	1	1	Tier 5	010000000000100000000	30											7										Tier 5	1	1	010000000000100000000		Tier 5	33											33										Tier 5																							4
H5402	015	0	1	01	01	H5402_015_0	4	4	1	Tier 4	100100	1	2	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							4
H5402	015	0	1	01	01	H5402_015_0	4	3	1	Tier 3	000110	3	2	Tier 3	010000000010010000000	30									30			30									Tier 3	2	2		010000000010010000000	Tier 3																						Tier 3	68.00									68.00			68.00										4
H5402	015	0	1	01	01	H5402_015_0	4	2	1	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00									4
H5402	015	0	1	01	01	H5402_015_0	4	1	1	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00									4
H5402	015	0	1	01	01	H5402_015_0	4	5	1	Tier 5	010010	1	1	Tier 5	010000000000100000000	30											7										Tier 5	1	1	010000000000100000000		Tier 5	33											33										Tier 5																							4
H5402	015	0	1	01	01	H5402_015_0	4	5	3	Tier 5	010010	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
H5402	015	0	1	01	01	H5402_015_0	4	4	3	Tier 4	100100	1	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5402	015	0	1	01	01	H5402_015_0	4	3	3	Tier 3	000110	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5402	015	0	1	01	01	H5402_015_0	4	2	3	Tier 2	010001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5402	015	0	1	01	01	H5402_015_0	4	1	3	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00								1	4
H5402	017	0	1	01	01	H5402_017_0	5	1	1	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00									4
H5402	017	0	1	01	01	H5402_017_0	5	2	1	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00									4
H5402	017	0	1	01	01	H5402_017_0	5	3	1	Tier 3	000110	3	2	Tier 3	010000000010010000000	30									30			30									Tier 3	2	2		010000000010010000000	Tier 3																						Tier 3	68.00									68.00			68.00										4
H5402	017	0	1	01	01	H5402_017_0	5	4	1	Tier 4	100100	1	2	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							4
H5402	017	0	1	01	01	H5402_017_0	5	5	3	Tier 5	010010	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
H5402	017	0	1	01	01	H5402_017_0	5	3	3	Tier 3	000110	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5402	017	0	1	01	01	H5402_017_0	5	2	3	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00								1	4
H5402	017	0	1	01	01	H5402_017_0	5	1	3	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00								1	4
H5402	017	0	1	01	01	H5402_017_0	5	5	1	Tier 5	010010	1	1	Tier 5	010000000000100000000	30											7										Tier 5	1	1	010000000000100000000		Tier 5	33											33										Tier 5																							4
H5402	017	0	1	01	01	H5402_017_0	5	4	3	Tier 4	100100	1	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5404	001	0	1	01	01	H5404_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	001	0	1	01	01	H5404_001_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	001	0	1	01	01	H5404_001_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	001	0	1	01	01	H5404_001_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	002	0	1	01	01	H5404_002_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	002	0	1	01	01	H5404_002_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	002	0	1	01	01	H5404_002_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	002	0	1	01	01	H5404_002_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	003	0	1	01	01	H5404_003_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	003	0	1	01	01	H5404_003_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	003	0	1	01	01	H5404_003_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	003	0	1	01	01	H5404_003_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	004	0	1	01	01	H5404_004_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	5.00	15.00		5.00	15.00		5.00	15.00		5.00				15.00	10.00		15.00	10.00					4
H5404	004	0	1	01	01	H5404_004_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	20.00	60.00		20.00	60.00		20.00	60.00		20.00				60.00	40.00		60.00	40.00					4
H5404	004	0	1	01	01	H5404_004_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	004	0	1	01	01	H5404_004_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	013	0	1	01	01	H5404_013_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	013	0	1	01	01	H5404_013_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	013	0	1	01	01	H5404_013_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	013	0	1	01	01	H5404_013_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	016	0	1	01	01	H5404_016_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	016	0	1	01	01	H5404_016_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	016	0	1	01	01	H5404_016_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	016	0	1	01	01	H5404_016_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	022	0	1	01	01	H5404_022_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	022	0	1	01	01	H5404_022_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	022	0	1	01	01	H5404_022_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	022	0	1	01	01	H5404_022_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	025	0	1	01	01	H5404_025_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	025	0	1	01	01	H5404_025_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	025	0	1	01	01	H5404_025_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	025	0	1	01	01	H5404_025_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	028	0	1	01	01	H5404_028_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	028	0	1	01	01	H5404_028_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	028	0	1	01	01	H5404_028_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	028	0	1	01	01	H5404_028_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	031	0	1	01	01	H5404_031_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	031	0	1	01	01	H5404_031_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	031	0	1	01	01	H5404_031_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	031	0	1	01	01	H5404_031_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	034	0	1	01	01	H5404_034_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	034	0	1	01	01	H5404_034_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	034	0	1	01	01	H5404_034_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	034	0	1	01	01	H5404_034_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	037	0	1	01	01	H5404_037_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	037	0	1	01	01	H5404_037_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	037	0	1	01	01	H5404_037_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	037	0	1	01	01	H5404_037_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	043	0	1	01	01	H5404_043_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	043	0	1	01	01	H5404_043_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	043	0	1	01	01	H5404_043_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	043	0	1	01	01	H5404_043_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	053	0	1	01	01	H5404_053_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	053	0	1	01	01	H5404_053_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	053	0	1	01	01	H5404_053_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	053	0	1	01	01	H5404_053_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	056	0	1	01	01	H5404_056_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	056	0	1	01	01	H5404_056_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	056	0	1	01	01	H5404_056_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	056	0	1	01	01	H5404_056_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	059	0	1	01	01	H5404_059_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	059	0	1	01	01	H5404_059_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	059	0	1	01	01	H5404_059_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	059	0	1	01	01	H5404_059_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	062	0	1	01	01	H5404_062_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	062	0	1	01	01	H5404_062_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	062	0	1	01	01	H5404_062_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	062	0	1	01	01	H5404_062_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	086	0	1	02	01	H5404_086_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	086	0	1	02	01	H5404_086_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	086	0	1	02	01	H5404_086_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	086	0	1	02	01	H5404_086_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	087	0	1	02	01	H5404_087_0	8	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	087	0	1	02	01	H5404_087_0	8	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	087	0	1	02	01	H5404_087_0	8	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	087	0	1	02	01	H5404_087_0	8	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	093	0	1	01	01	H5404_093_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	093	0	1	01	01	H5404_093_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	093	0	1	01	01	H5404_093_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	093	0	1	01	01	H5404_093_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	094	0	1	01	01	H5404_094_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	094	0	1	01	01	H5404_094_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	094	0	1	01	01	H5404_094_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	094	0	1	01	01	H5404_094_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	096	0	1	01	01	H5404_096_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	096	0	1	01	01	H5404_096_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	096	0	1	01	01	H5404_096_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	096	0	1	01	01	H5404_096_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	101	0	1	01	01	H5404_101_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	101	0	1	01	01	H5404_101_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	101	0	1	01	01	H5404_101_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	101	0	1	01	01	H5404_101_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	102	0	1	01	01	H5404_102_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	102	0	1	01	01	H5404_102_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	102	0	1	01	01	H5404_102_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	102	0	1	01	01	H5404_102_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	105	0	1	01	01	H5404_105_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	105	0	1	01	01	H5404_105_0	7	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	105	0	1	01	01	H5404_105_0	7	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	105	0	1	01	01	H5404_105_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	106	0	1	01	01	H5404_106_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	106	0	1	01	01	H5404_106_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	106	0	1	01	01	H5404_106_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	106	0	1	01	01	H5404_106_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5404	108	0	1	01	01	H5404_108_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5404	108	0	1	01	01	H5404_108_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5404	108	0	1	01	01	H5404_108_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5404	108	0	1	01	01	H5404_108_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5407	001	0	1	01	01	H5407_001_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	001	0	1	01	01	H5407_001_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00									4
H5407	001	0	1	01	01	H5407_001_0	6	4	3	Tier 4 Specialty	100010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5407	001	0	1	01	01	H5407_001_0	6	3	3	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5407	001	0	1	01	01	H5407_001_0	6	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5407	001	0	1	01	01	H5407_001_0	6	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00								1	4
H5407	001	0	1	01	01	H5407_001_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	001	0	1	01	01	H5407_001_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	004	0	1	01	01	H5407_004_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	004	0	1	01	01	H5407_004_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	004	0	1	01	01	H5407_004_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	004	0	1	01	01	H5407_004_0	6	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00								1	4
H5407	004	0	1	01	01	H5407_004_0	6	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5407	004	0	1	01	01	H5407_004_0	6	3	3	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5407	004	0	1	01	01	H5407_004_0	6	4	3	Tier 4 Specialty	100010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5407	004	0	1	01	01	H5407_004_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00									4
H5407	005	0	1	01	01	H5407_005_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	15.00	30.00										15.00		30.00									4
H5407	005	0	1	01	01	H5407_005_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	005	0	1	01	01	H5407_005_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	005	0	1	01	01	H5407_005_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	5.00	10.00										5.00		10.00									4
H5407	006	0	1	01	01	H5407_006_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	006	0	1	01	01	H5407_006_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00									4
H5407	006	0	1	01	01	H5407_006_0	6	4	3	Tier 4 Specialty	100010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5407	006	0	1	01	01	H5407_006_0	6	3	3	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5407	006	0	1	01	01	H5407_006_0	6	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5407	006	0	1	01	01	H5407_006_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	006	0	1	01	01	H5407_006_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	006	0	1	01	01	H5407_006_0	6	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00								1	4
H5407	007	0	1	01	01	H5407_007_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00									4
H5407	007	0	1	01	01	H5407_007_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	007	0	1	01	01	H5407_007_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	007	0	1	01	01	H5407_007_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	007	0	1	01	01	H5407_007_0	6	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00								1	4
H5407	007	0	1	01	01	H5407_007_0	6	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5407	007	0	1	01	01	H5407_007_0	6	3	3	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5407	007	0	1	01	01	H5407_007_0	6	4	3	Tier 4 Specialty	100010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5407	008	0	1	01	01	H5407_008_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00									4
H5407	008	0	1	01	01	H5407_008_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	008	0	1	01	01	H5407_008_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	008	0	1	01	01	H5407_008_0	6	4	3	Tier 4 Specialty	100010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5407	008	0	1	01	01	H5407_008_0	6	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00								1	4
H5407	008	0	1	01	01	H5407_008_0	6	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5407	008	0	1	01	01	H5407_008_0	6	3	3	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5407	008	0	1	01	01	H5407_008_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	009	0	1	01	01	H5407_009_0	6	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00								1	4
H5407	009	0	1	01	01	H5407_009_0	6	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5407	009	0	1	01	01	H5407_009_0	6	3	3	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5407	009	0	1	01	01	H5407_009_0	6	4	3	Tier 4 Specialty	100010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5407	009	0	1	01	01	H5407_009_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00									4
H5407	009	0	1	01	01	H5407_009_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	009	0	1	01	01	H5407_009_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	009	0	1	01	01	H5407_009_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	010	0	1	01	01	H5407_010_0	6	3	3	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5407	010	0	1	01	01	H5407_010_0	6	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5407	010	0	1	01	01	H5407_010_0	6	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00								1	4
H5407	010	0	1	01	01	H5407_010_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	010	0	1	01	01	H5407_010_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	010	0	1	01	01	H5407_010_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	010	0	1	01	01	H5407_010_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00									4
H5407	010	0	1	01	01	H5407_010_0	6	4	3	Tier 4 Specialty	100010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5407	011	0	1	01	01	H5407_011_0	6	1	1	Tier 1 Generics	010000	1	2	Tier 1 Generics	011000000000101000000	30	90										5		90								Tier 1 Generics	2	2		011000000000101000000	Tier 1 Generics																						Tier 1 Generics	0.00	0.00										0.00		0.00									4
H5407	011	0	1	01	01	H5407_011_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	011	0	1	01	01	H5407_011_0	6	4	1	Tier 4 Non-Preferred Brand Speciality	100010	1	1	Tier 4 Non-Preferred Brand Speciality	010000000000100000000	30											5										Tier 4 Non-Preferred Brand Speciality	2	1	010000000000100000000		Tier 4 Non-Preferred Brand Speciality	20											20										Tier 4 Non-Preferred Brand Speciality																							4
H5407	011	0	1	01	01	H5407_011_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	012	0	1	01	01	H5407_012_0	5	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00									4
H5407	012	0	1	01	01	H5407_012_0	5	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	012	0	1	01	01	H5407_012_0	5	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	012	0	1	01	01	H5407_012_0	5	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	012	0	1	01	01	H5407_012_0	5	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00								1	4
H5407	012	0	1	01	01	H5407_012_0	5	3	3	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5407	012	0	1	01	01	H5407_012_0	5	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5407	012	0	1	01	01	H5407_012_0	5	4	3	Tier 4 Specialty	100010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5407	013	0	1	01	01	H5407_013_0	5	3	3	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5407	013	0	1	01	01	H5407_013_0	5	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5407	013	0	1	01	01	H5407_013_0	5	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00								1	4
H5407	013	0	1	01	01	H5407_013_0	5	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	013	0	1	01	01	H5407_013_0	5	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	013	0	1	01	01	H5407_013_0	5	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	0.00	0.00										0.00		0.00									4
H5407	013	0	1	01	01	H5407_013_0	5	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	0.00	0.00										0.00		0.00									4
H5407	013	0	1	01	01	H5407_013_0	5	4	3	Tier 4 Specialty	100010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5407	014	0	1	01	01	H5407_014_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	5.00	10.00										5.00		10.00									4
H5407	014	0	1	01	01	H5407_014_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	15.00	30.00										15.00		30.00									4
H5407	014	0	1	01	01	H5407_014_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	014	0	1	01	01	H5407_014_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	015	0	1	01	01	H5407_015_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	5.00	10.00										5.00		10.00									4
H5407	015	0	1	01	01	H5407_015_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	15.00	30.00										15.00		30.00									4
H5407	015	0	1	01	01	H5407_015_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	015	0	1	01	01	H5407_015_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	016	0	1	01	01	H5407_016_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	5.00	10.00										5.00		10.00									4
H5407	016	0	1	01	01	H5407_016_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	016	0	1	01	01	H5407_016_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	15.00	30.00										15.00		30.00									4
H5407	016	0	1	01	01	H5407_016_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	017	0	1	01	01	H5407_017_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	5.00	10.00										5.00		10.00									4
H5407	017	0	1	01	01	H5407_017_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	15.00	30.00										15.00		30.00									4
H5407	017	0	1	01	01	H5407_017_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	017	0	1	01	01	H5407_017_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	018	0	1	01	01	H5407_018_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	5.00	10.00										5.00		10.00									4
H5407	018	0	1	01	01	H5407_018_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	15.00	30.00										15.00		30.00									4
H5407	018	0	1	01	01	H5407_018_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	018	0	1	01	01	H5407_018_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	019	0	1	01	01	H5407_019_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	5.00	10.00										5.00		10.00									4
H5407	019	0	1	01	01	H5407_019_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	15.00	30.00										15.00		30.00									4
H5407	019	0	1	01	01	H5407_019_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5407	019	0	1	01	01	H5407_019_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	020	0	1	01	01	H5407_020_0	6	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000000101000000	30	90										5		90								Tier 1 Generic	2	2		011000000000101000000	Tier 1 Generic																						Tier 1 Generic	5.00	10.00										5.00		10.00									4
H5407	020	0	1	01	01	H5407_020_0	6	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011000000000101000000	30	90										5		90								Tier 2 Preferred Brand	2	2		011000000000101000000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	15.00	30.00										15.00		30.00									4
H5407	020	0	1	01	01	H5407_020_0	6	3	1	Tier 3 Non-Preferred Brand	100010	1	2	Tier 3 Non-Preferred Brand	011000000000101000000	30	90										5		90								Tier 3 Non-Preferred Brand	2	2		011000000000101000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	25.00	50.00										25.00		50.00									4
H5407	020	0	1	01	01	H5407_020_0	6	4	1	Tier 4 Specialty	100010	1	1	Tier 4 Specialty	010000000000100000000	30											5										Tier 4 Specialty	2	1	010000000000100000000		Tier 4 Specialty	20											20										Tier 4 Specialty																							4
H5410	001	0	1	01	01	H5410_001_0	3	1	1	Generic	010000	3	2	Generic	000010010010000000000				30			30			30												Generic	2	2		000010010010000000000	Generic																						Generic				0.00			5.00			5.00													4
H5410	001	0	1	01	01	H5410_001_0	3	2	1	Brand Name	000010	1	2	Brand Name	000010010010000000000				30			30			30												Brand Name	1	2		000010010010000000000	Brand Name																						Brand Name				0.00			10.00			10.00													4
H5410	001	0	1	01	01	H5410_001_0	3	3	1	Specialty	010010	1	1	Specialty	000010010010000000000				30			30			30												Specialty	2	1	000010010010000000000		Specialty				25			25			25												Specialty																							4
H5410	001	0	1	01	01	H5410_001_0	3	1	3	Generic	010000	3	2	Generic	000010010010000000000				30			30			30												Generic	2	2		000010010010000000000	Generic																						Generic				0.00			5.00			5.00												1	4
H5410	001	0	1	01	01	H5410_001_0	3	2	3	Brand Name	000010	1	2	Brand Name																							Brand Name					Brand Name																						Brand Name																						2	4
H5410	001	0	1	01	01	H5410_001_0	3	3	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5414	002	0	1	01	01	H5414_002_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5414	002	0	1	01	01	H5414_002_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H5414	002	0	1	01	01	H5414_002_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5414	004	0	1	01	01	H5414_004_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5414	004	0	1	01	01	H5414_004_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5414	004	0	1	01	01	H5414_004_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5414	004	0	1	01	01	H5414_004_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H5414	004	0	1	01	01	H5414_004_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H5414	004	0	1	01	01	H5414_004_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H5414	004	0	1	01	01	H5414_004_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H5414	004	0	1	01	01	H5414_004_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H5414	006	0	1	01	01	H5414_006_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5414	006	0	1	01	01	H5414_006_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H5414	006	0	1	01	01	H5414_006_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5414	007	0	1	01	01	H5414_007_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H5414	007	0	1	01	01	H5414_007_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5414	007	0	1	01	01	H5414_007_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5414	008	0	1	01	01	H5414_008_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5414	008	0	1	01	01	H5414_008_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5414	008	0	1	01	01	H5414_008_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H5414	008	0	1	01	01	H5414_008_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5414	008	0	1	01	01	H5414_008_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H5414	008	0	1	01	01	H5414_008_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H5414	008	0	1	01	01	H5414_008_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H5414	008	0	1	01	01	H5414_008_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H5414	009	0	1	01	01	H5414_009_0	4	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H5414	009	0	1	01	01	H5414_009_0	4	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5414	009	0	1	01	01	H5414_009_0	4	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5415	039	0	1	04	01	H5415_039_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
H5415	039	0	1	04	01	H5415_039_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H5415	039	0	1	04	01	H5415_039_0	4	3	1	Other Non-Preferred	100100	1	2	Other Non-Preferred	011000000010011000000	30	90								30			30	90								Other Non-Preferred	2	2		011000000010011000000	Other Non-Preferred																						Other Non-Preferred	70.00	210.00								70.00			70.00	175.00									4
H5415	039	0	1	04	01	H5415_039_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	33									33			33									Specialty																							4
H5416	001	0	1	01	01	H5416_001_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5416	001	0	1	01	01	H5416_001_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5416	001	0	1	01	01	H5416_001_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5416	001	0	1	01	01	H5416_001_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5416	001	0	1	01	01	H5416_001_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5416	001	0	1	01	01	H5416_001_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5416	001	0	1	01	01	H5416_001_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5416	001	0	1	01	01	H5416_001_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5416	002	0	1	01	01	H5416_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5416	002	0	1	01	01	H5416_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5416	002	0	1	01	01	H5416_002_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5416	002	0	1	01	01	H5416_002_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5416	002	0	1	01	01	H5416_002_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5416	002	0	1	01	01	H5416_002_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5416	002	0	1	01	01	H5416_002_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5416	002	0	1	01	01	H5416_002_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5416	004	0	1	01	01	H5416_004_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5416	004	0	1	01	01	H5416_004_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5416	004	0	1	01	01	H5416_004_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5416	004	0	1	01	01	H5416_004_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5416	004	0	1	01	01	H5416_004_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5416	004	0	1	01	01	H5416_004_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5416	004	0	1	01	01	H5416_004_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5416	004	0	1	01	01	H5416_004_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5416	005	0	1	01	01	H5416_005_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5416	005	0	1	01	01	H5416_005_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5416	005	0	1	01	01	H5416_005_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5416	005	0	1	01	01	H5416_005_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5416	005	0	1	01	01	H5416_005_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5416	005	0	1	01	01	H5416_005_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5416	005	0	1	01	01	H5416_005_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5416	005	0	1	01	01	H5416_005_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5417	001	0	1	04	01	H5417_001_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H5417	001	0	1	04	01	H5417_001_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5417	001	0	1	04	01	H5417_001_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H5417	001	0	1	04	01	H5417_001_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5417	005	0	1	04	01	H5417_005_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H5417	005	0	1	04	01	H5417_005_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5417	005	0	1	04	01	H5417_005_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H5417	005	0	1	04	01	H5417_005_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H5417	006	0	1	04	01	H5417_006_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5417	006	0	1	04	01	H5417_006_0	9	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H5417	006	0	1	04	01	H5417_006_0	9	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5417	006	0	1	04	01	H5417_006_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H5418	001	0	1	04	01	H5418_001_0	9	7	1	Specialty	010010	1	1	Specialty	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Specialty	1	1	011011011011011011011		Specialty	25	25		25	25		25	25		25	25		25	25		25	25		25	25		Specialty																							4
H5418	001	0	1	04	01	H5418_001_0	9	6	1	Injectable	010010	1	2	Injectable	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Injectable	1	1	011011011011011011011		Injectable	20	20		20	20		20	20		20	20		20	20		20	20		20	20		Injectable																							4
H5418	001	0	1	04	01	H5418_001_0	9	5	1	Brand	100000	1	2	Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Brand	1	2		011011011011011011011	Brand																						Brand	50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00		50.00	100.00		50.00	100.00		50.00	100.00			4
H5418	001	0	1	04	01	H5418_001_0	9	3	1	Program Managed	000010	1	2	Program Managed	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Program Managed	1	2		011011011011011011011	Program Managed																						Program Managed	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H5418	001	0	1	04	01	H5418_001_0	9	4	1	Preferred Brand	000001	1	2	Preferred Brand	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Brand	1	2		011011011011011011011	Preferred Brand																						Preferred Brand	25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00		25.00	50.00		25.00	50.00		25.00	50.00			4
H5418	001	0	1	04	01	H5418_001_0	9	1	1	Preferred Generic	011000	1	2	Preferred Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Preferred Generic	2	2		011011011011011011011	Preferred Generic																						Preferred Generic	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			4
H5418	001	0	1	04	01	H5418_001_0	9	2	1	Generic	010100	1	2	Generic	011011011011011011011	31	93		31	93		31	93		31	93		31	93		31	93		31	93		Generic	2	2		011011011011011011011	Generic																						Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00		5.00	10.00		5.00	10.00		5.00	10.00			4
H5419	004	0	1	09	04	H5419_004_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5419	004	0	1	09	04	H5419_004_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5419	004	0	1	09	04	H5419_004_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5419	004	0	1	09	04	H5419_004_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H5419	004	0	1	09	04	H5419_004_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H5419	009	0	1	09	04	H5419_009_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5419	009	0	1	09	04	H5419_009_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5419	009	0	1	09	04	H5419_009_0	6	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H5419	009	0	1	09	04	H5419_009_0	6	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H5419	009	0	1	09	04	H5419_009_0	6	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
H5419	009	0	1	09	04	H5419_009_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5419	009	0	1	09	04	H5419_009_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5419	009	0	1	09	04	H5419_009_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5419	009	0	1	09	04	H5419_009_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H5419	009	0	1	09	04	H5419_009_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H5420	001	0	1	05	01	H5420_001_0	4	1	1	Generic	010000	3	2	Generic	000010010010000000000				30			30			30												Generic	2	2		000010010010000000000	Generic																						Generic				0.00			0.00			0.00													4
H5420	001	0	1	05	01	H5420_001_0	4	4	1	Non-Preferred Brand	000010	1	2	Non-Preferred Brand	000010010010000000000				30			30			30												Non-Preferred Brand	2	2		000010010010000000000	Non-Preferred Brand																						Non-Preferred Brand				20.00			25.00			25.00													4
H5420	001	0	1	05	01	H5420_001_0	4	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	2	1	000010010010000000000		Specialty Drugs				25			25			25												Specialty Drugs																							4
H5420	001	0	1	05	01	H5420_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000010010010000000000				30			30			30												Preferred Brand	2	2		000010010010000000000	Preferred Brand																						Preferred Brand				0.00			0.00			0.00													4
H5420	001	0	1	05	01	H5420_001_0	4	3	1	Formulary Brand	000010	1	2	Formulary Brand	000010010010000000000				30			30			30												Formulary Brand	2	2		000010010010000000000	Formulary Brand																						Formulary Brand				5.00			10.00			10.00													4
H5420	003	0	1	05	01	H5420_003_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5420	003	0	1	05	01	H5420_003_0	4	3	3	Formulary Brand	000010	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5420	003	0	1	05	01	H5420_003_0	4	4	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5420	003	0	1	05	01	H5420_003_0	4	5	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5420	003	0	1	05	01	H5420_003_0	4	1	3	Generic	010000	3	2	Generic	000010010010000000000				30			30			30												Generic	2	2		000010010010000000000	Generic																						Generic				0.00			0.00			0.00												1	4
H5420	003	0	1	05	01	H5420_003_0	4	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	2	1	000010010010000000000		Specialty Drugs				25			25			25												Specialty Drugs																							4
H5420	003	0	1	05	01	H5420_003_0	4	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010010010000000000				30			30			30												Non-Preferred Brand	2	2		000010010010000000000	Non-Preferred Brand																						Non-Preferred Brand				20.00			25.00			25.00													4
H5420	003	0	1	05	01	H5420_003_0	4	1	1	Generic	010000	3	2	Generic	000010010010000000000				30			30			30												Generic	2	2		000010010010000000000	Generic																						Generic				0.00			0.00			0.00													4
H5420	003	0	1	05	01	H5420_003_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000010010010000000000				30			30			30												Preferred Brand	2	2		000010010010000000000	Preferred Brand																						Preferred Brand				0.00			0.00			0.00													4
H5420	003	0	1	05	01	H5420_003_0	4	3	1	Formulary Brand	000010	1	2	Formulary Brand	000010010010000000000				30			30			30												Formulary Brand	2	2		000010010010000000000	Formulary Brand																						Formulary Brand				5.00			10.00			10.00													4
H5420	004	0	1	05	01	H5420_004_0	3	1	1	Generic	010000	3	2	Generic	000010010010000000000				30			30			30												Generic	2	2		000010010010000000000	Generic																						Generic				0.00			0.00			0.00													4
H5420	004	0	1	05	01	H5420_004_0	3	3	1	Formulary Brand	000010	1	2	Formulary Brand	000010010010000000000				30			30			30												Formulary Brand	2	2		000010010010000000000	Formulary Brand																						Formulary Brand				5.00			10.00			10.00													4
H5420	004	0	1	05	01	H5420_004_0	3	5	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5420	004	0	1	05	01	H5420_004_0	3	4	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5420	004	0	1	05	01	H5420_004_0	3	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010010010000000000				30			30			30												Non-Preferred Brand	2	2		000010010010000000000	Non-Preferred Brand																						Non-Preferred Brand				20.00			25.00			25.00													4
H5420	004	0	1	05	01	H5420_004_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	000010010010000000000				30			30			30												Preferred Brand	2	2		000010010010000000000	Preferred Brand																						Preferred Brand				0.00			0.00			0.00													4
H5420	004	0	1	05	01	H5420_004_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand	000010010010000000000				30			30			30												Preferred Brand	2	2		000010010010000000000	Preferred Brand																						Preferred Brand				0.00			0.00			0.00												1	4
H5420	004	0	1	05	01	H5420_004_0	3	1	3	Generic	010000	3	2	Generic	000010010010000000000				30			30			30												Generic	2	2		000010010010000000000	Generic																						Generic				0.00			0.00			0.00												1	4
H5420	004	0	1	05	01	H5420_004_0	3	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	2	1	000010010010000000000		Specialty Drugs				25			25			25												Specialty Drugs																							4
H5420	004	0	1	05	01	H5420_004_0	3	3	3	Formulary Brand	000010	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5420	005	0	1	05	01	H5420_005_0	3	5	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5420	005	0	1	05	01	H5420_005_0	3	4	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5420	005	0	1	05	01	H5420_005_0	3	3	3	Formulary Brand	000010	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5420	005	0	1	05	01	H5420_005_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5420	005	0	1	05	01	H5420_005_0	3	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	2	1	000010010010000000000		Specialty Drugs				25			25			25												Specialty Drugs																							4
H5420	005	0	1	05	01	H5420_005_0	3	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000010010010000000000				30			30			30												Non-Preferred Brand	2	2		000010010010000000000	Non-Preferred Brand																						Non-Preferred Brand				20.00			25.00			25.00													4
H5420	005	0	1	05	01	H5420_005_0	3	3	1	Formulary Brand	000010	1	2	Formulary Brand	000010010010000000000				30			30			30												Formulary Brand	2	2		000010010010000000000	Formulary Brand																						Formulary Brand				10.00			15.00			15.00													4
H5420	005	0	1	05	01	H5420_005_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	000010010010000000000				30			30			30												Preferred Brand	2	2		000010010010000000000	Preferred Brand																						Preferred Brand				5.00			10.00			10.00													4
H5420	005	0	1	05	01	H5420_005_0	3	1	1	Generic	010000	3	2	Generic	000010010010000000000				30			30			30												Generic	2	2		000010010010000000000	Generic																						Generic				0.00			0.00			0.00													4
H5420	005	0	1	05	01	H5420_005_0	3	1	3	Generic	010000	3	2	Generic	000010010010000000000				30			30			30												Generic	2	2		000010010010000000000	Generic																						Generic				0.00			0.00			0.00												1	4
H5420	006	0	1	05	01	H5420_006_0	4	3	1	Brand	000010	1	2	Brand	010000000010000000000	30									30												Brand	2	1	010000000010000000000		Brand	25									25												Brand																							4
H5420	006	0	1	05	01	H5420_006_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5420	006	0	1	05	01	H5420_006_0	4	1	1	Generic	010000	3	2	Generic	010000000010000000000	30									30												Generic	2	2		010000000010000000000	Generic																						Generic	0.00									0.00													4
H5420	006	0	1	05	01	H5420_006_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	010000000010000000000	30									30												Preferred Brand	2	2		010000000010000000000	Preferred Brand																						Preferred Brand	0.00									0.00													4
H5421	040	0	1	09	04	H5421_040_0	6	4	1	Tier 4	100000		1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							3
H5421	040	0	1	09	04	H5421_040_0	6	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	61.00	122.00								61.00	122.00			122.00									3
H5421	040	0	1	09	04	H5421_040_0	6	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									3
H5421	040	0	1	09	04	H5421_040_0	6	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									3
H5421	041	0	1	09	04	H5421_041_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5421	041	0	1	09	04	H5421_041_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5421	041	0	1	09	04	H5421_041_0	5	4	3	Tier 4	100000	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5421	041	0	1	09	04	H5421_041_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									4
H5421	041	0	1	09	04	H5421_041_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									4
H5421	041	0	1	09	04	H5421_041_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	61.00	122.00								61.00	122.00			122.00									4
H5421	041	0	1	09	04	H5421_041_0	5	4	1	Tier 4	100000	1	1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
H5421	041	0	1	09	04	H5421_041_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00								1	4
H5421	042	0	1	09	04	H5421_042_0	6	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	61.00	122.00								61.00	122.00			122.00									3
H5421	042	0	1	09	04	H5421_042_0	6	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									3
H5421	042	0	1	09	04	H5421_042_0	6	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									3
H5421	042	0	1	09	04	H5421_042_0	6	4	1	Tier 4	100000		1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							3
H5421	043	0	1	09	04	H5421_043_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00								1	4
H5421	043	0	1	09	04	H5421_043_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5421	043	0	1	09	04	H5421_043_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5421	043	0	1	09	04	H5421_043_0	5	4	1	Tier 4	100000	1	1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
H5421	043	0	1	09	04	H5421_043_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	61.00	122.00								61.00	122.00			122.00									4
H5421	043	0	1	09	04	H5421_043_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									4
H5421	043	0	1	09	04	H5421_043_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									4
H5421	043	0	1	09	04	H5421_043_0	5	4	3	Tier 4	100000	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5421	044	0	1	09	04	H5421_044_0	5	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	61.00	122.00								61.00	122.00			122.00									3
H5421	044	0	1	09	04	H5421_044_0	5	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									3
H5421	044	0	1	09	04	H5421_044_0	5	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									3
H5421	044	0	1	09	04	H5421_044_0	5	4	1	Tier 4	100000		1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							3
H5421	045	0	1	09	04	H5421_045_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00								1	4
H5421	045	0	1	09	04	H5421_045_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5421	045	0	1	09	04	H5421_045_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5421	045	0	1	09	04	H5421_045_0	5	4	1	Tier 4	100000	1	1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
H5421	045	0	1	09	04	H5421_045_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	61.00	122.00								61.00	122.00			122.00									4
H5421	045	0	1	09	04	H5421_045_0	5	4	3	Tier 4	100000	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5421	045	0	1	09	04	H5421_045_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	7.00	14.00								7.00	14.00			14.00									4
H5421	045	0	1	09	04	H5421_045_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	31.00	62.00								31.00	62.00			62.00									4
H5422	001	0	1	01	01	H5422_001_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5422	001	0	1	01	01	H5422_001_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5422	001	0	1	01	01	H5422_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H5422	001	0	1	01	01	H5422_001_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H5422	001	0	1	01	01	H5422_001_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5422	002	0	1	01	01	H5422_002_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5422	002	0	1	01	01	H5422_002_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5422	002	0	1	01	01	H5422_002_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H5422	002	0	1	01	01	H5422_002_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H5422	002	0	1	01	01	H5422_002_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5422	003	0	1	01	01	H5422_003_0	9	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	0.00	0.00								0.00							0.00			0.00			3
H5422	003	0	1	01	01	H5422_003_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	40.00	120.00								40.00							80.00			120.00			3
H5422	003	0	1	01	01	H5422_003_0	9	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00							80.00			120.00			3
H5422	003	0	1	01	01	H5422_003_0	9	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
H5422	003	0	1	01	01	H5422_003_0	9	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
H5422	005	0	1	01	01	H5422_005_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H5422	005	0	1	01	01	H5422_005_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H5422	005	0	1	01	01	H5422_005_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5422	005	0	1	01	01	H5422_005_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5422	005	0	1	01	01	H5422_005_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5424	001	0	1	04	01	H5424_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H5424	001	0	1	04	01	H5424_001_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5424	001	0	1	04	01	H5424_001_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H5424	001	0	1	04	01	H5424_001_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5424	005	0	1	04	01	H5424_005_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H5424	005	0	1	04	01	H5424_005_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H5424	005	0	1	04	01	H5424_005_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H5424	005	0	1	04	01	H5424_005_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5425	001	0	1	01	01	H5425_001_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	25.00								15.00				25.00									4
H5425	001	0	1	01	01	H5425_001_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	31	90								31				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	75.00								40.00				75.00									4
H5425	001	0	1	01	01	H5425_001_0	10	3	1	Formulary Specialty	010010	1	1	Formulary Specialty	010000000000100000000	31											10										Formulary Specialty	2	1	010000000000100000000		Formulary Specialty	25											25										Formulary Specialty																							4
H5425	001	0	1	01	01	H5425_001_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	25.00								15.00				25.00								1	4
H5425	001	0	1	01	01	H5425_001_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5425	001	0	1	01	01	H5425_001_0	10	3	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H5425	003	0	1	01	01	H5425_003_0	9	3	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H5425	003	0	1	01	01	H5425_003_0	9	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5425	003	0	1	01	01	H5425_003_0	9	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	25.00								15.00				25.00								1	4
H5425	003	0	1	01	01	H5425_003_0	9	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	25.00								15.00				25.00									4
H5425	003	0	1	01	01	H5425_003_0	9	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	31	90								31				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	75.00								40.00				75.00									4
H5425	003	0	1	01	01	H5425_003_0	9	3	1	Formulary Specialty	010010	1	1	Formulary Specialty	010000000000100000000	31											10										Formulary Specialty	2	1	010000000000100000000		Formulary Specialty	25											25										Formulary Specialty																							4
H5425	004	0	1	01	01	H5425_004_0	10	3	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H5425	004	0	1	01	01	H5425_004_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	10.00								10.00				10.00									4
H5425	004	0	1	01	01	H5425_004_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	31	90								31				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	28.00	56.00								40.00				56.00									4
H5425	004	0	1	01	01	H5425_004_0	10	3	1	Formulary Specialty	010010	1	1	Formulary Specialty	010000000000100000000	31											10										Formulary Specialty	2	1	010000000000100000000		Formulary Specialty	25											25										Formulary Specialty																							4
H5425	004	0	1	01	01	H5425_004_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	10.00								10.00				10.00								1	4
H5425	004	0	1	01	01	H5425_004_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5425	005	0	1	01	01	H5425_005_0	9	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	7.00	14.00								10.00				14.00									4
H5425	005	0	1	01	01	H5425_005_0	9	3	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H5425	005	0	1	01	01	H5425_005_0	9	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5425	005	0	1	01	01	H5425_005_0	9	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	7.00	14.00								10.00				14.00								1	4
H5425	005	0	1	01	01	H5425_005_0	9	3	1	Formulary Specialty	010010	1	1	Formulary Specialty	010000000000100000000	31											10										Formulary Specialty	2	1	010000000000100000000		Formulary Specialty	25											25										Formulary Specialty																							4
H5425	005	0	1	01	01	H5425_005_0	9	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	31	90								31				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	28.00	56.00								40.00				56.00									4
H5426	001	0	1	01	01	H5426_001_0	15	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									3
H5426	001	0	1	01	01	H5426_001_0	15	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00			90.00									3
H5426	001	0	1	01	01	H5426_001_0	15	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00			180.00									3
H5426	001	0	1	01	01	H5426_001_0	15	4	1	Specialty	101000		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H5426	002	0	1	01	01	H5426_002_0	15	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									3
H5426	002	0	1	01	01	H5426_002_0	15	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00			90.00									3
H5426	002	0	1	01	01	H5426_002_0	15	4	1	Specialty	101000		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H5426	002	0	1	01	01	H5426_002_0	15	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00			180.00									3
H5426	003	0	1	01	01	H5426_003_0	12	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									3
H5426	003	0	1	01	01	H5426_003_0	12	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00			180.00									3
H5426	003	0	1	01	01	H5426_003_0	12	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00			90.00									3
H5426	003	0	1	01	01	H5426_003_0	12	4	1	Specialty	101000		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H5426	007	0	1	02	01	H5426_007_0	18	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									3
H5426	007	0	1	02	01	H5426_007_0	18	2	1	Perferred Brand	000001		2	Perferred Brand	011000000011001000000	30	90								30	90			90								Perferred Brand	2	2		011000000011001000000	Perferred Brand																						Perferred Brand	30.00	90.00								30.00	90.00			90.00									3
H5426	007	0	1	02	01	H5426_007_0	18	4	1	Specialty	100000		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H5426	007	0	1	02	01	H5426_007_0	18	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00			180.00									3
H5426	008	0	1	02	01	H5426_008_0	18	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									3
H5426	008	0	1	02	01	H5426_008_0	18	2	1	Perferred Brand	000001		2	Perferred Brand	011000000011001000000	30	90								30	90			90								Perferred Brand	2	2		011000000011001000000	Perferred Brand																						Perferred Brand	30.00	90.00								30.00	90.00			90.00									3
H5426	008	0	1	02	01	H5426_008_0	18	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00			180.00									3
H5426	008	0	1	02	01	H5426_008_0	18	4	1	Specialty	100000		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H5426	009	0	1	02	01	H5426_009_0	17	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									3
H5426	009	0	1	02	01	H5426_009_0	17	2	1	Perferred Brand	000001		2	Perferred Brand	011000000011001000000	30	90								30	90			90								Perferred Brand	2	2		011000000011001000000	Perferred Brand																						Perferred Brand	30.00	90.00								30.00	90.00			90.00									3
H5426	009	0	1	02	01	H5426_009_0	17	4	1	Specialty	100000		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H5426	009	0	1	02	01	H5426_009_0	17	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00			180.00									3
H5426	013	0	1	01	01	H5426_013_0	17	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									3
H5426	013	0	1	01	01	H5426_013_0	17	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	45.00	135.00								45.00	135.00			135.00									3
H5426	013	0	1	01	01	H5426_013_0	17	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	210.00								70.00	210.00			210.00									3
H5426	013	0	1	01	01	H5426_013_0	17	4	1	Specialty	100000		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H5426	014	0	1	01	01	H5426_014_0	17	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									3
H5426	014	0	1	01	01	H5426_014_0	17	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	45.00	135.00								45.00	135.00			135.00									3
H5426	014	0	1	01	01	H5426_014_0	17	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	210.00								70.00	210.00			210.00									3
H5426	014	0	1	01	01	H5426_014_0	17	4	1	Specialty	100000		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H5426	015	0	1	01	01	H5426_015_0	16	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	210.00								70.00	210.00			210.00									3
H5426	015	0	1	01	01	H5426_015_0	16	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	45.00	135.00								45.00	135.00			135.00									3
H5426	015	0	1	01	01	H5426_015_0	16	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									3
H5426	015	0	1	01	01	H5426_015_0	16	4	1	Specialty	100000		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H5427	001	0	1	01	01	H5427_001_0	6	1	1	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H5427	001	0	1	01	01	H5427_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00				30.00									4
H5427	001	0	1	01	01	H5427_001_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00								30.00				60.00									4
H5427	001	0	1	01	01	H5427_001_0	6	4	1	Specialty	010010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
H5427	002	0	1	01	01	H5427_002_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00								30.00				60.00									4
H5427	002	0	1	01	01	H5427_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00				30.00									4
H5427	002	0	1	01	01	H5427_002_0	3	1	1	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H5427	002	0	1	01	01	H5427_002_0	3	4	1	Specialty	010010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
H5427	003	0	1	01	01	H5427_003_0	3	1	1	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H5427	003	0	1	01	01	H5427_003_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00				30.00									4
H5427	003	0	1	01	01	H5427_003_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00								30.00				60.00									4
H5427	003	0	1	01	01	H5427_003_0	3	4	1	Specialty	010010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
H5427	010	0	1	01	01	H5427_010_0	5	1	1	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H5427	010	0	1	01	01	H5427_010_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00				30.00									4
H5427	010	0	1	01	01	H5427_010_0	5	4	1	Specialty	010010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
H5427	010	0	1	01	01	H5427_010_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00								30.00				60.00									4
H5427	015	0	1	01	01	H5427_015_0	5	1	1	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H5427	015	0	1	01	01	H5427_015_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00								45.00				90.00									4
H5427	015	0	1	01	01	H5427_015_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5427	015	0	1	01	01	H5427_015_0	5	4	1	Specialty	010010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	33	33								33												Specialty																							4
H5427	020	0	1	01	01	H5427_020_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00								45.00				90.00									4
H5427	020	0	1	01	01	H5427_020_0	5	4	1	Specialty	010010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	33	33								33												Specialty																							4
H5427	020	0	1	01	01	H5427_020_0	5	1	1	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H5427	020	0	1	01	01	H5427_020_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5427	021	0	1	01	01	H5427_021_0	5	1	1	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H5427	021	0	1	01	01	H5427_021_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5427	021	0	1	01	01	H5427_021_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00								45.00				90.00									4
H5427	021	0	1	01	01	H5427_021_0	5	4	1	Specialty	010010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	33	33								33												Specialty																							4
H5427	022	0	1	01	01	H5427_022_0	4	1	1	Generic	010000	3	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00									4
H5427	022	0	1	01	01	H5427_022_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5427	022	0	1	01	01	H5427_022_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00								45.00				90.00									4
H5427	022	0	1	01	01	H5427_022_0	4	4	1	Specialty	010010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	33	33								33												Specialty																							4
H5427	050	0	1	01	01	H5427_050_0	5	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	25.00	50.00								25.00	50.00			50.00									4
H5427	050	0	1	01	01	H5427_050_0	5	3	1	Non-Formulary Brand	100000	3	2	Non-Formulary Brand	011000000011001000000	30	90								30	90			90								Non-Formulary Brand	2	2		011000000011001000000	Non-Formulary Brand																						Non-Formulary Brand	50.00	100.00								50.00	100.00			100.00									4
H5427	050	0	1	01	01	H5427_050_0	5	1	1	Generic	010000	3	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									4
H5429	001	0	1	04	01	H5429_001_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5429	001	0	1	04	01	H5429_001_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5429	001	0	1	04	01	H5429_001_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5429	001	0	1	04	01	H5429_001_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5429	005	0	1	04	01	H5429_005_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5429	005	0	1	04	01	H5429_005_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5429	005	0	1	04	01	H5429_005_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5429	005	0	1	04	01	H5429_005_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5429	007	0	1	04	01	H5429_007_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5429	007	0	1	04	01	H5429_007_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5429	007	0	1	04	01	H5429_007_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5429	007	0	1	04	01	H5429_007_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5429	011	0	1	04	01	H5429_011_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5429	011	0	1	04	01	H5429_011_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5429	011	0	1	04	01	H5429_011_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5429	011	0	1	04	01	H5429_011_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5429	015	0	1	04	01	H5429_015_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5429	015	0	1	04	01	H5429_015_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5429	015	0	1	04	01	H5429_015_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5429	015	0	1	04	01	H5429_015_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5429	020	0	1	04	01	H5429_020_0	6	1	1	Tier 1	010000	1	2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					4
H5429	020	0	1	04	01	H5429_020_0	6	2	1	Tier 2	000101	1	2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	15.00	45.00		15.00	45.00		15.00	45.00		15.00				45.00	30.00		45.00	30.00					4
H5429	020	0	1	04	01	H5429_020_0	6	3	1	Tier 3	100000	1	2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00				150.00	100.00		150.00	100.00					4
H5429	020	0	1	04	01	H5429_020_0	6	4	1	Tier 4	100100	1	1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							4
H5431	001	0	1	01	01	H5431_001_0	6	2	1	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand	000010010010000000000				30			30			30												Formulary Preferred Brand	2	2		000010010010000000000	Formulary Preferred Brand																						Formulary Preferred Brand				0.00			0.00			0.00													4
H5431	001	0	1	01	01	H5431_001_0	6	3	1	Formulary Brand	000010	3	2	Formulary Brand	000010010010000000000				30			30			30												Formulary Brand	2	2		000010010010000000000	Formulary Brand																						Formulary Brand				0.00			10.00			10.00													4
H5431	001	0	1	01	01	H5431_001_0	6	4	1	Non-Preferred Brand	100010	3	1	Non-Preferred Brand	000010010010000000000				30			30			30												Non-Preferred Brand	2	2		000010010010000000000	Non-Preferred Brand																						Non-Preferred Brand				40.00			40.00			40.00													4
H5431	001	0	1	01	01	H5431_001_0	6	1	1	Formulary Generic	001000	3	2	Formulary Generic	000010010010000000000				30			30			30												Formulary Generic	2	2		000010010010000000000	Formulary Generic																						Formulary Generic				0.00			0.00			0.00													4
H5431	002	0	1	01	01	H5431_002_0	6	4	1	Non-Preferred Brand	100010	3	1	Non-Preferred Brand	000010010010000000000				30			30			30												Non-Preferred Brand	2	2		000010010010000000000	Non-Preferred Brand																						Non-Preferred Brand				40.00			40.00			40.00													4
H5431	002	0	1	01	01	H5431_002_0	6	1	1	Formulary Generic	001000	3	2	Formulary Generic	000010010010000000000				30			30			30												Formulary Generic	2	2		000010010010000000000	Formulary Generic																						Formulary Generic				0.00			0.00			0.00													4
H5431	002	0	1	01	01	H5431_002_0	6	2	1	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand	000010010010000000000				30			30			30												Formulary Preferred Brand	2	2		000010010010000000000	Formulary Preferred Brand																						Formulary Preferred Brand				0.00			10.00			10.00													4
H5431	002	0	1	01	01	H5431_002_0	6	3	1	Formulary Brand	000010	3	2	Formulary Brand	000010010010000000000				30			30			30												Formulary Brand	2	2		000010010010000000000	Formulary Brand																						Formulary Brand				0.00			10.00			10.00													4
H5431	003	0	1	01	01	H5431_003_0	6	4	1	Non-Preferred Brand	100010	3	1	Non-Preferred Brand	000010010010000000000				30			30			30												Non-Preferred Brand	2	2		000010010010000000000	Non-Preferred Brand																						Non-Preferred Brand				35.00			35.00			35.00													4
H5431	003	0	1	01	01	H5431_003_0	6	3	1	Formulary Brand	000010	3	2	Formulary Brand	000010010010000000000				30			30			30												Formulary Brand	2	2		000010010010000000000	Formulary Brand																						Formulary Brand				0.00			10.00			20.00													4
H5431	003	0	1	01	01	H5431_003_0	6	1	1	Formulary Generic	001000	3	2	Formulary Generic	000010010010000000000				30			30			30												Formulary Generic	2	2		000010010010000000000	Formulary Generic																						Formulary Generic				0.00			0.00			5.00													4
H5431	003	0	1	01	01	H5431_003_0	6	2	1	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand	000010010010000000000				30			30			30												Formulary Preferred Brand	2	2		000010010010000000000	Formulary Preferred Brand																						Formulary Preferred Brand				0.00			10.00			20.00													4
H5433	001	0	1	01	01	H5433_001_0	10	2	1	Brand Name	000010	1	2	Brand Name	000001001010000000000					90			90		30												Brand Name	2	2		000001001010000000000	Brand Name																						Brand Name					135.00			135.00		54.00													4
H5433	001	0	1	01	01	H5433_001_0	10	1	1	Generic	010000	1	2	Generic	000001001010000000000					90			90		30												Generic	2	2		000001001010000000000	Generic																						Generic					0.00			0.00		0.00													4
H5434	001	0	1	04	01	H5434_001_0	3	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 2 Preferred Brand	2	2		011100000011111100000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	25.00	75.00	50.00							25.00	75.00	50.00	25.00	75.00	50.00								4
H5434	001	0	1	04	01	H5434_001_0	3	5	3	Excluded Generic	010000	2	2	Excluded Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Excluded Generic	2	2		011100000011111100000	Excluded Generic																						Excluded Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00							1	4
H5434	001	0	1	04	01	H5434_001_0	3	4	3	Tier 4 Specialty	110001	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5434	001	0	1	04	01	H5434_001_0	3	3	3	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5434	001	0	1	04	01	H5434_001_0	3	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5434	001	0	1	04	01	H5434_001_0	3	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00							1	4
H5434	001	0	1	04	01	H5434_001_0	3	5	1	Excluded Generic	010000	2	2	Excluded Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Excluded Generic	2	2		011100000011111100000	Excluded Generic																						Excluded Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
H5434	001	0	1	04	01	H5434_001_0	3	4	1	Tier 4 Specialty	110001	1	1	Tier 4 Specialty	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 4 Specialty	2	1	011100000011111100000		Tier 4 Specialty	25	25	25							25	25	25	25	25	25							Tier 4 Specialty																							4
H5434	001	0	1	04	01	H5434_001_0	3	3	1	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 3 Non-Preferred Brand	2	2		011100000011111100000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H5434	001	0	1	04	01	H5434_001_0	3	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
H5434	002	0	1	04	01	H5434_002_0	3	5	3	Excluded Generic	010000	2	2	Excluded Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Excluded Generic	2	2		011100000011111100000	Excluded Generic																						Excluded Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00							1	4
H5434	002	0	1	04	01	H5434_002_0	3	4	3	Tier 4 Specialty	110001	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H5434	002	0	1	04	01	H5434_002_0	3	3	3	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
H5434	002	0	1	04	01	H5434_002_0	3	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5434	002	0	1	04	01	H5434_002_0	3	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00							1	4
H5434	002	0	1	04	01	H5434_002_0	3	5	1	Excluded Generic	010000	2	2	Excluded Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Excluded Generic	2	2		011100000011111100000	Excluded Generic																						Excluded Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
H5434	002	0	1	04	01	H5434_002_0	3	4	1	Tier 4 Specialty	110001	1	1	Tier 4 Specialty	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 4 Specialty	2	1	011100000011111100000		Tier 4 Specialty	25	25	25							25	25	25	25	25	25							Tier 4 Specialty																							4
H5434	002	0	1	04	01	H5434_002_0	3	3	1	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 3 Non-Preferred Brand	2	2		011100000011111100000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H5434	002	0	1	04	01	H5434_002_0	3	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 2 Preferred Brand	2	2		011100000011111100000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	25.00	75.00	50.00							25.00	75.00	50.00	25.00	75.00	50.00								4
H5434	002	0	1	04	01	H5434_002_0	3	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
H5435	013	0	1	09	04	H5435_013_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010000001001				30	90		30	90		30							90			90		Preferred Brand	2	2		000011011010000001001	Preferred Brand																						Preferred Brand				29.00	87.00		29.00	87.00		29.00							77.00			87.00			4
H5435	013	0	1	09	04	H5435_013_0	4	4	1	Specialty	010010	1	1	Specialty	000011011010000001001				30	90		30	90		30							90			90		Specialty	2	1	000011011010000001001		Specialty				33	33		33	33		33							33			33		Specialty																							4
H5435	013	0	1	09	04	H5435_013_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	000011011010000001001				30	90		30	90		30							90			90		Preferred Generic	2	2		000011011010000001001	Preferred Generic																						Preferred Generic				5.00	15.00		5.00	15.00		5.00							10.00			15.00			4
H5435	013	0	1	09	04	H5435_013_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	000011011010000001001				30	90		30	90		30							90			90		Non-Preferred	2	2		000011011010000001001	Non-Preferred																						Non-Preferred				60.00	180.00		60.00	180.00		60.00							170.00			180.00			4
H5436	001	0	1	04	01	H5436_001_0	9	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	1	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									3
H5436	001	0	1	04	01	H5436_001_0	9	2	1	Preferred Brand Name	000001		2	Preferred Brand Name	011000000010001000000	30	90								30				90								Preferred Brand Name	1	2		011000000010001000000	Preferred Brand Name																						Preferred Brand Name	25.00	75.00								50.00				75.00									3
H5436	001	0	1	04	01	H5436_001_0	9	3	1	Non-Preferred Brand Name	100000		2	Non-Preferred Brand Name	011000000010001000000	30	90								30				90								Non-Preferred Brand Name	1	2		011000000010001000000	Non-Preferred Brand Name																						Non-Preferred Brand Name	50.00	150.00								100.00				150.00									3
H5436	001	0	1	04	01	H5436_001_0	9	4	1	Specialty	010010		1	Specialty	010000000010000000000	30									30												Specialty	1	1	010000000010000000000		Specialty	33									33												Specialty																							3
H5436	002	0	1	04	01	H5436_002_0	9	2	1	Preferred Brand Name	000001		2	Preferred Brand Name	011000000010001000000	30	90								30				90								Preferred Brand Name	1	2		011000000010001000000	Preferred Brand Name																						Preferred Brand Name	25.00	75.00								50.00				75.00									3
H5436	002	0	1	04	01	H5436_002_0	9	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	1	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									3
H5436	002	0	1	04	01	H5436_002_0	9	3	1	Non-Preferred Brand Name	100000		2	Non-Preferred Brand Name	011000000010001000000	30	90								30				90								Non-Preferred Brand Name	1	2		011000000010001000000	Non-Preferred Brand Name																						Non-Preferred Brand Name	50.00	150.00								100.00				150.00									3
H5436	002	0	1	04	01	H5436_002_0	9	4	1	Specialty	010010		1	Specialty	010000000010000000000	30									30												Specialty	1	1	010000000010000000000		Specialty	33									33												Specialty																							3
H5437	001	0	1	04	01	H5437_001_0	6	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H5437	001	0	1	04	01	H5437_001_0	6	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5437	001	0	1	04	01	H5437_001_0	6	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5439	001	0	1	04	01	H5439_001_0	6	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
H5439	001	0	1	04	01	H5439_001_0	6	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
H5439	001	0	1	04	01	H5439_001_0	6	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	58.00	174.00	116.00							58.00	174.00	116.00		145.00	116.00								4
H5439	001	0	1	04	01	H5439_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								4
H5439	001	0	1	04	01	H5439_001_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								4
H5440	001	0	1	01	01	H5440_001_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H5440	001	0	1	01	01	H5440_001_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5440	001	0	1	01	01	H5440_001_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H5440	001	0	1	01	01	H5440_001_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H5485	001	0	1	09	04	H5485_001_0	5	1	1	Generic	010000		2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00								3
H5485	001	0	1	09	04	H5485_001_0	5	2	1	Preferred  Brand	000001		2	Preferred  Brand	000010110110100100000				30		60	30		60	30		60			60							Preferred  Brand	2	2		000010110110100100000	Preferred  Brand																						Preferred  Brand				22.00		44.00	22.00		44.00	22.00		44.00			44.00								3
H5485	001	0	1	09	04	H5485_001_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Non-Preferred Brand	2	2		000010110110100100000	Non-Preferred Brand																						Non-Preferred Brand				37.00		74.00	37.00		74.00	37.00		74.00			74.00								3
H5485	002	0	1	09	04	H5485_002_0	5	1	1	Generic	010000		2	Generic	000010110110100100000				30		60	30		60	30		60			60							Generic	2	2		000010110110100100000	Generic																						Generic				0.00		0.00	0.00		0.00	0.00		0.00			0.00								3
H5485	002	0	1	09	04	H5485_002_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Preferred Brand	2	2		000010110110100100000	Preferred Brand																						Preferred Brand				22.00		44.00	22.00		44.00	22.00		44.00			44.00								3
H5485	002	0	1	09	04	H5485_002_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000010110110100100000				30		60	30		60	30		60			60							Non-Preferred Brand	2	2		000010110110100100000	Non-Preferred Brand																						Non-Preferred Brand				37.00		74.00	37.00		74.00	37.00		74.00			74.00								3
H5500	001	0	1	04	01	H5500_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H5500	001	0	1	04	01	H5500_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5500	001	0	1	04	01	H5500_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H5500	001	0	1	04	01	H5500_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5501	001	0	1	04	01	H5501_001_0	7	4	1	Specialty	100010	1	1	Specialty	000011011011011000000				30	90		30	90		30	90		30	90								Specialty	2	1	000011011011011000000		Specialty				20	20		20	20		20	20		20	20								Specialty																							4
H5501	001	0	1	04	01	H5501_001_0	7	1	1	Generic	011100	1	2	Generic	000011011011001000000				30	90		30	90		30	90			90								Generic	2	2		000011011011001000000	Generic																						Generic				5.00	0.00		5.00	15.00		5.00	15.00			0.00									4
H5501	001	0	1	04	01	H5501_001_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011011001000000				30	90		30	90		30	90			90								Preferred Brand	2	2		000011011011001000000	Preferred Brand																						Preferred Brand				25.00	25.00		25.00	75.00		25.00	75.00			25.00									4
H5501	001	0	1	04	01	H5501_001_0	7	3	1	Non-Preferred Brand	000100	1	2	Non-Preferred Brand	000011011011001000000				30	90		30	90		30	90			90								Non-Preferred Brand	2	2		000011011011001000000	Non-Preferred Brand																						Non-Preferred Brand				40.00	40.00		40.00	120.00		40.00	120.00			40.00									4
H5507	001	0	1	04	01	H5507_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H5507	001	0	1	04	01	H5507_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5507	001	0	1	04	01	H5507_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5507	001	0	1	04	01	H5507_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H5508	001	0	1	04	01	H5508_001_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011000011011000000				30	90					30	90		30	90								Non-Preferred Brand	2	2		000011000011011000000	Non-Preferred Brand																						Non-Preferred Brand				58.00	174.00					58.00	174.00		58.00	116.00									3
H5508	001	0	1	04	01	H5508_001_0	5	4	1	Specialty	100000		1	Specialty	000011000011011000000				30	90					30	90		30	90								Specialty	2	1	000011000011011000000		Specialty				25	25					25	25		25	25								Specialty																							3
H5508	001	0	1	04	01	H5508_001_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	000011000011011000000				30	90					30	90		30	90								Preferred Brand	2	2		000011000011011000000	Preferred Brand																						Preferred Brand				29.00	87.00					29.00	87.00		29.00	58.00									3
H5508	001	0	1	04	01	H5508_001_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	000011000011011000000				30	90					30	90		30	90								Formulary Generic	2	2		000011000011011000000	Formulary Generic																						Formulary Generic				10.00	30.00					10.00	30.00		10.00	20.00									3
H5509	001	0	1	04	01	H5509_001_0	5	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00								1	4
H5509	001	0	1	04	01	H5509_001_0	5	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									4
H5509	001	0	1	04	01	H5509_001_0	5	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H5509	001	0	1	04	01	H5509_001_0	5	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5509	001	0	1	04	01	H5509_001_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5509	001	0	1	04	01	H5509_001_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5509	001	0	1	04	01	H5509_001_0	5	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00				100.00									4
H5509	001	0	1	04	01	H5509_001_0	5	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5509	003	0	1	04	01	H5509_003_0	6	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5509	003	0	1	04	01	H5509_003_0	6	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H5509	003	0	1	04	01	H5509_003_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5509	003	0	1	04	01	H5509_003_0	6	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00								1	4
H5509	003	0	1	04	01	H5509_003_0	6	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5509	003	0	1	04	01	H5509_003_0	6	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00				100.00									4
H5509	003	0	1	04	01	H5509_003_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5509	003	0	1	04	01	H5509_003_0	6	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									4
H5510	002	0	1	04	01	H5510_002_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5510	002	0	1	04	01	H5510_002_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5510	002	0	1	04	01	H5510_002_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5510	002	0	1	04	01	H5510_002_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H5510	002	0	1	04	01	H5510_002_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5510	002	0	1	04	01	H5510_002_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5510	002	0	1	04	01	H5510_002_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5510	002	0	1	04	01	H5510_002_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5510	003	0	1	04	01	H5510_003_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H5510	003	0	1	04	01	H5510_003_0	4	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5510	003	0	1	04	01	H5510_003_0	4	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H5510	003	0	1	04	01	H5510_003_0	4	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5510	003	0	1	04	01	H5510_003_0	4	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5510	003	0	1	04	01	H5510_003_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H5510	005	0	1	04	01	H5510_005_0	4	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H5510	005	0	1	04	01	H5510_005_0	4	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5510	005	0	1	04	01	H5510_005_0	4	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5510	005	0	1	04	01	H5510_005_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H5510	005	0	1	04	01	H5510_005_0	4	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5510	005	0	1	04	01	H5510_005_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H5510	006	0	1	04	01	H5510_006_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5510	006	0	1	04	01	H5510_006_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H5510	006	0	1	04	01	H5510_006_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5510	006	0	1	04	01	H5510_006_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5510	006	0	1	04	01	H5510_006_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5510	006	0	1	04	01	H5510_006_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5510	006	0	1	04	01	H5510_006_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5510	006	0	1	04	01	H5510_006_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5512	001	0	1	04	01	H5512_001_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H5512	001	0	1	04	01	H5512_001_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5512	001	0	1	04	01	H5512_001_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5512	002	0	1	04	01	H5512_002_0	6	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
H5512	002	0	1	04	01	H5512_002_0	6	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5512	002	0	1	04	01	H5512_002_0	6	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
H5512	002	0	1	04	01	H5512_002_0	6	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5512	005	0	1	04	01	H5512_005_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5512	005	0	1	04	01	H5512_005_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H5512	005	0	1	04	01	H5512_005_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5512	006	0	1	04	01	H5512_006_0	5	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H5512	006	0	1	04	01	H5512_006_0	5	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5512	006	0	1	04	01	H5512_006_0	5	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H5512	006	0	1	04	01	H5512_006_0	5	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5512	006	0	1	04	01	H5512_006_0	5	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H5512	006	0	1	04	01	H5512_006_0	5	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5512	008	0	1	04	01	H5512_008_0	4	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H5512	008	0	1	04	01	H5512_008_0	4	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5512	008	0	1	04	01	H5512_008_0	4	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5512	009	0	1	04	01	H5512_009_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5512	009	0	1	04	01	H5512_009_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H5512	009	0	1	04	01	H5512_009_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H5512	009	0	1	04	01	H5512_009_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5512	009	0	1	04	01	H5512_009_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5512	009	0	1	04	01	H5512_009_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5512	009	0	1	04	01	H5512_009_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5512	009	0	1	04	01	H5512_009_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5516	001	0	1	04	01	H5516_001_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5516	001	0	1	04	01	H5516_001_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H5516	001	0	1	04	01	H5516_001_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H5516	001	0	1	04	01	H5516_001_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5517	001	0	1	04	01	H5517_001_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5517	001	0	1	04	01	H5517_001_0	3	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H5517	001	0	1	04	01	H5517_001_0	3	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5517	001	0	1	04	01	H5517_001_0	3	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00									4
H5517	001	0	1	04	01	H5517_001_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5517	001	0	1	04	01	H5517_001_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
H5517	001	0	1	04	01	H5517_001_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5517	001	0	1	04	01	H5517_001_0	3	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00								1	4
H5520	002	0	1	04	01	H5520_002_0	10	1	1	Tier 1	010000	1	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	1	2		000011011010001000000	Tier 1																						Tier 1				5.00	15.00		5.00	15.00		5.00				10.00									4
H5520	002	0	1	04	01	H5520_002_0	10	2	1	Tier 2	000001	1	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	1	2		000011011010001000000	Tier 2																						Tier 2				29.00	87.00		29.00	87.00		29.00				58.00									4
H5520	002	0	1	04	01	H5520_002_0	10	3	1	Tier 3	100100	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	1	2		000011011010001000000	Tier 3																						Tier 3				58.00	174.00		58.00	174.00		58.00				145.00									4
H5520	002	0	1	04	01	H5520_002_0	10	5	1	Tier 5 Speciality	010010	1	1	Tier 5 Speciality	000011011010001000000				30	90		30	90		30				90								Tier 5 Speciality	1	1	000011011010001000000		Tier 5 Speciality				33	33		33	33		33				33								Tier 5 Speciality																							4
H5520	002	0	1	04	01	H5520_002_0	10	4	1	Tier 4 Injectables	010010	1	2	Tier 4 Injectables	000011011010001000000				30	90		30	90		30				90								Tier 4 Injectables	1	1	000011011010001000000		Tier 4 Injectables				33	33		33	33		33				33								Tier 4 Injectables																							4
H5520	004	0	1	04	01	H5520_004_0	11	3	1	Tier 3	100100	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	1	2		000011011010001000000	Tier 3																						Tier 3				58.00	174.00		58.00	174.00		58.00				145.00									4
H5520	004	0	1	04	01	H5520_004_0	11	4	1	Tier 4 Injectables	010010	1	2	Tier 4 Injectables	000011011010001000000				30	90		30	90		30				90								Tier 4 Injectables	1	1	000011011010001000000		Tier 4 Injectables				33	33		33	33		33				33								Tier 4 Injectables																							4
H5520	004	0	1	04	01	H5520_004_0	11	2	1	Tier 2	000001	1	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	1	2		000011011010001000000	Tier 2																						Tier 2				29.00	87.00		29.00	87.00		29.00				58.00									4
H5520	004	0	1	04	01	H5520_004_0	11	5	1	Tier 5 Speciality	010010	1	1	Tier 5 Speciality	000011011010001000000				30	90		30	90		30				90								Tier 5 Speciality	1	1	000011011010001000000		Tier 5 Speciality				33	33		33	33		33				33								Tier 5 Speciality																							4
H5520	004	0	1	04	01	H5520_004_0	11	1	1	Tier 1	010000	1	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	1	2		000011011010001000000	Tier 1																						Tier 1				5.00	15.00		5.00	15.00		5.00				10.00									4
H5520	005	0	1	04	01	H5520_005_0	10	4	1	Tier 4 Injectables	010010		2	Tier 4 Injectables	000011011010001000000				30	90		30	90		30				90								Tier 4 Injectables	1	1	000011011010001000000		Tier 4 Injectables				33	33		33	33		33				33								Tier 4 Injectables																							3
H5520	005	0	1	04	01	H5520_005_0	10	5	1	Tier 5 Speciality	010010		1	Tier 5 Speciality	000011011010001000000				30	90		30	90		30				90								Tier 5 Speciality	1	1	000011011010001000000		Tier 5 Speciality				33	33		33	33		33				33								Tier 5 Speciality																							3
H5520	005	0	1	04	01	H5520_005_0	10	1	1	Tier 1	010000		2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	1	2		000011011010001000000	Tier 1																						Tier 1				6.00	18.00		6.00	18.00		6.00				12.00									3
H5520	005	0	1	04	01	H5520_005_0	10	3	1	Tier 3	100100		2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	1	2		000011011010001000000	Tier 3																						Tier 3				80.00	240.00		80.00	240.00		80.00				200.00									3
H5520	005	0	1	04	01	H5520_005_0	10	2	1	Tier 2	000001		2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	1	2		000011011010001000000	Tier 2																						Tier 2				40.00	120.00		40.00	120.00		40.00				80.00									3
H5520	006	0	1	04	01	H5520_006_0	9	5	1	Tier 5 Speciality	010010		1	Tier 5 Speciality	000011011010001000000				30	90		30	90		30				90								Tier 5 Speciality	1	1	000011011010001000000		Tier 5 Speciality				33	33		33	33		33				33								Tier 5 Speciality																							3
H5520	006	0	1	04	01	H5520_006_0	9	1	1	Tier 1	010000		2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	1	2		000011011010001000000	Tier 1																						Tier 1				6.00	18.00		6.00	18.00		6.00				12.00									3
H5520	006	0	1	04	01	H5520_006_0	9	2	1	Tier 2	000001		2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	1	2		000011011010001000000	Tier 2																						Tier 2				40.00	120.00		40.00	120.00		40.00				80.00									3
H5520	006	0	1	04	01	H5520_006_0	9	4	1	Tier 4 Injectables	010010		2	Tier 4 Injectables	000011011010001000000				30	90		30	90		30				90								Tier 4 Injectables	1	1	000011011010001000000		Tier 4 Injectables				33	33		33	33		33				33								Tier 4 Injectables																							3
H5520	006	0	1	04	01	H5520_006_0	9	3	1	Tier 3	100100		2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	1	2		000011011010001000000	Tier 3																						Tier 3				80.00	240.00		80.00	240.00		80.00				200.00									3
H5521	002	0	1	04	01	H5521_002_0	7	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5521	002	0	1	04	01	H5521_002_0	7	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H5521	002	0	1	04	01	H5521_002_0	7	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5521	003	0	1	04	01	H5521_003_0	6	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5521	003	0	1	04	01	H5521_003_0	6	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5521	003	0	1	04	01	H5521_003_0	6	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5521	003	0	1	04	01	H5521_003_0	6	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5521	003	0	1	04	01	H5521_003_0	6	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5521	003	0	1	04	01	H5521_003_0	6	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H5521	003	0	1	04	01	H5521_003_0	6	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5521	003	0	1	04	01	H5521_003_0	6	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5521	005	0	1	04	01	H5521_005_0	4	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5521	005	0	1	04	01	H5521_005_0	4	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H5521	005	0	1	04	01	H5521_005_0	4	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5521	006	0	1	04	01	H5521_006_0	6	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5521	006	0	1	04	01	H5521_006_0	6	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H5521	006	0	1	04	01	H5521_006_0	6	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5521	006	0	1	04	01	H5521_006_0	6	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5521	006	0	1	04	01	H5521_006_0	6	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5521	006	0	1	04	01	H5521_006_0	6	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5521	006	0	1	04	01	H5521_006_0	6	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5521	006	0	1	04	01	H5521_006_0	6	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5521	008	0	1	04	01	H5521_008_0	4	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H5521	008	0	1	04	01	H5521_008_0	4	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5521	008	0	1	04	01	H5521_008_0	4	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5521	009	0	1	04	01	H5521_009_0	8	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5521	009	0	1	04	01	H5521_009_0	8	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5521	009	0	1	04	01	H5521_009_0	8	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5521	009	0	1	04	01	H5521_009_0	8	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5521	009	0	1	04	01	H5521_009_0	8	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5521	009	0	1	04	01	H5521_009_0	8	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5521	009	0	1	04	01	H5521_009_0	8	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5521	009	0	1	04	01	H5521_009_0	8	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H5522	001	0	1	04	01	H5522_001_0	6	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H5522	001	0	1	04	01	H5522_001_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5522	001	0	1	04	01	H5522_001_0	6	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00								1	4
H5522	001	0	1	04	01	H5522_001_0	6	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5522	001	0	1	04	01	H5522_001_0	6	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
H5522	001	0	1	04	01	H5522_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5522	001	0	1	04	01	H5522_001_0	6	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00									4
H5522	001	0	1	04	01	H5522_001_0	6	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5522	002	0	1	04	01	H5522_002_0	6	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5522	002	0	1	04	01	H5522_002_0	6	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00								1	4
H5522	002	0	1	04	01	H5522_002_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5522	002	0	1	04	01	H5522_002_0	6	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H5522	002	0	1	04	01	H5522_002_0	6	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5522	002	0	1	04	01	H5522_002_0	6	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
H5522	002	0	1	04	01	H5522_002_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5522	002	0	1	04	01	H5522_002_0	6	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00				140.00									4
H5522	003	0	1	04	01	H5522_003_0	6	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00									4
H5522	003	0	1	04	01	H5522_003_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5522	003	0	1	04	01	H5522_003_0	6	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
H5522	003	0	1	04	01	H5522_003_0	6	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5522	003	0	1	04	01	H5522_003_0	6	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				8.00								1	4
H5522	003	0	1	04	01	H5522_003_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5522	003	0	1	04	01	H5522_003_0	6	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H5522	003	0	1	04	01	H5522_003_0	6	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5523	001	0	1	04	01	H5523_001_0	10	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Non-preferred Brand	2	2		000011011011011000000	Non-preferred Brand																						Non-preferred Brand				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H5523	001	0	1	04	01	H5523_001_0	10	1	1	Generics	010000		2	Generics	000011011011011000000				30	90		30	90		30	90		30	90								Generics	2	2		000011011011011000000	Generics																						Generics				8.00	24.00		8.00	24.00		8.00	24.00		8.00	24.00									3
H5523	001	0	1	04	01	H5523_001_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011011011000000				30	90		30	90		30	90		30	90								Preferred Brand	2	2		000011011011011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00	75.00		25.00	75.00		25.00	75.00									3
H5523	001	0	1	04	01	H5523_001_0	10	4	1	Biologicals and Injectibles	010010		2	Biologicals and Injectibles	000011011011011000000				30	90		30	90		30	90		30	90								Biologicals and Injectibles	2	2		000011011011011000000	Biologicals and Injectibles																						Biologicals and Injectibles				50.00	150.00		50.00	150.00		50.00	150.00		50.00	150.00									3
H5525	001	0	1	04	01	H5525_001_0	3	1	3	Formulary Preferred Generic	001000	1	2	Formulary Preferred Generic	011000000010011000000	30	90								10			30	90								Formulary Preferred Generic	2	2		011000000010011000000	Formulary Preferred Generic																						Formulary Preferred Generic	8.00	16.00								8.00			8.00	16.00								1	4
H5525	001	0	1	04	01	H5525_001_0	3	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010011000000	30	90								10			30	90								Formulary Preferred Brand	2	1	011000000010011000000		Formulary Preferred Brand	50	50								50			50	50								Formulary Preferred Brand																						1	4
H5525	001	0	1	04	01	H5525_001_0	3	3	3	Formulary Non - Preferred	100100	1	2	Formulary Non - Preferred	011000000010011000000	30	90								10			30	90								Formulary Non - Preferred	2	1	011000000010011000000		Formulary Non - Preferred	50	50								50			50	50								Formulary Non - Preferred																						1	4
H5525	001	0	1	04	01	H5525_001_0	3	4	3	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010011000000	30	90								10			30	90								Formulary Specialty	2	1	011000000010011000000		Formulary Specialty	50	50								50			50	50								Formulary Specialty																						1	4
H5525	001	0	1	04	01	H5525_001_0	3	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010011000000	30	90								10			30	90								Formulary Preferred Brand	2	2		011000000010011000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	60.00								30.00			30.00	60.00									4
H5525	001	0	1	04	01	H5525_001_0	3	1	1	Formulary Preferred Generic	001000	1	2	Formulary Preferred Generic	011000000010011000000	30	90								10			30	90								Formulary Preferred Generic	2	2		011000000010011000000	Formulary Preferred Generic																						Formulary Preferred Generic	8.00	16.00								8.00			8.00	16.00									4
H5525	001	0	1	04	01	H5525_001_0	3	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010011000000	30	90								10			30	90								Formulary Specialty	2	1	011000000010011000000		Formulary Specialty	30	30								30			30	30								Formulary Specialty																							4
H5525	001	0	1	04	01	H5525_001_0	3	3	1	Formulary Non - Preferred	100100	1	2	Formulary Non - Preferred	011000000010011000000	30	90								10			30	90								Formulary Non - Preferred	2	1	011000000010011000000		Formulary Non - Preferred	50	50								50			50	50								Formulary Non - Preferred																							4
H5525	003	0	1	04	01	H5525_003_0	5	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010011000000	30	90								10			30	90								Formulary Specialty	2	1	011000000010011000000		Formulary Specialty	30	30								30			30	30								Formulary Specialty																							4
H5525	003	0	1	04	01	H5525_003_0	5	3	1	Formulary Non - Preferred	100100	1	2	Formulary Non - Preferred	011000000010011000000	30	90								10			30	90								Formulary Non - Preferred	2	1	011000000010011000000		Formulary Non - Preferred	50	50								50			50	50								Formulary Non - Preferred																							4
H5525	003	0	1	04	01	H5525_003_0	5	1	1	Formulary Preferred Generic	001000	1	2	Formulary Preferred Generic	011000000010011000000	30	90								10			30	90								Formulary Preferred Generic	2	2		011000000010011000000	Formulary Preferred Generic																						Formulary Preferred Generic	8.00	16.00								8.00			8.00	16.00									4
H5525	003	0	1	04	01	H5525_003_0	5	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010011000000	30	90								10			30	90								Formulary Preferred Brand	2	2		011000000010011000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	60.00								30.00			30.00	60.00									4
H5525	004	0	1	04	01	H5525_004_0	5	3	1	Non Preferred Formulary	100100		2	Non Preferred Formulary	011000000000111000000	30	90										10	30	90								Non Preferred Formulary	2	2		011000000000111000000	Non Preferred Formulary																						Non Preferred Formulary	48.00	96.00										48.00	48.00	96.00									3
H5525	004	0	1	04	01	H5525_004_0	5	2	1	Preferred Brand Formulary	000001		2	Preferred Brand Formulary	011000000000111000000	30	90										10	30	90								Preferred Brand Formulary	2	2		011000000000111000000	Preferred Brand Formulary																						Preferred Brand Formulary	32.00	64.00										32.00	32.00	64.00									3
H5525	004	0	1	04	01	H5525_004_0	5	1	1	Preferred Generic Formulary	001000		2	Preferred Generic Formulary	011000000000111000000	30	90										10	30	90								Preferred Generic Formulary	2	2		011000000000111000000	Preferred Generic Formulary																						Preferred Generic Formulary	8.00	16.00										8.00	8.00	16.00									3
H5525	004	0	1	04	01	H5525_004_0	5	4	1	Specialty Formulary	010010		1	Specialty Formulary	011000000000111000000	30	90										10	30	90								Specialty Formulary	2	2		011000000000111000000	Specialty Formulary																						Specialty Formulary	48.00	96.00										48.00	48.00	96.00									3
H5526	003	0	1	04	01	H5526_003_0	7	1	1	Formulary Generic	001000		2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00									3
H5526	003	0	1	04	01	H5526_003_0	7	2	1	Formulary Brand	000001		2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									3
H5526	003	0	1	04	01	H5526_003_0	7	4	1	Specialty Injectibles	100001		1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							3
H5526	003	0	1	04	01	H5526_003_0	7	3	1	Non-Preferred Brand/Generic	100100		2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							3
H5526	004	0	1	04	01	H5526_004_0	6	1	1	Formulary Generic	001000		2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00									3
H5526	004	0	1	04	01	H5526_004_0	6	3	1	Non-Preferred Brand/Generic	100100		2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							3
H5526	004	0	1	04	01	H5526_004_0	6	2	1	Formulary Brand	000001		2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									3
H5526	004	0	1	04	01	H5526_004_0	6	4	1	Specialty Injectibles	100001		1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							3
H5526	007	0	1	04	01	H5526_007_0	6	4	1	Specialty Injectibles	100001	1	1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							4
H5526	007	0	1	04	01	H5526_007_0	6	1	3	Formulary Generic	001000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00								1	4
H5526	007	0	1	04	01	H5526_007_0	6	2	3	Formulary Brand	000001	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5526	007	0	1	04	01	H5526_007_0	6	3	3	Non-Preferred Brand/Generic	100100	1	2	Non-Preferred Brand/Generic																							Non-Preferred Brand/Generic					Non-Preferred Brand/Generic																						Non-Preferred Brand/Generic																						2	4
H5526	007	0	1	04	01	H5526_007_0	6	4	3	Specialty Injectibles	100001	1	1	Specialty Injectibles																							Specialty Injectibles					Specialty Injectibles																						Specialty Injectibles																						2	4
H5526	007	0	1	04	01	H5526_007_0	6	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00									4
H5526	007	0	1	04	01	H5526_007_0	6	2	1	Formulary Brand	000001	1	2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									4
H5526	007	0	1	04	01	H5526_007_0	6	3	1	Non-Preferred Brand/Generic	100100	1	2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							4
H5526	008	0	1	04	01	H5526_008_0	6	2	1	Formulary Brand	000001	1	2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									4
H5526	008	0	1	04	01	H5526_008_0	6	3	3	Non-Preferred Brand/Generic	100100	1	2	Non-Preferred Brand/Generic																							Non-Preferred Brand/Generic					Non-Preferred Brand/Generic																						Non-Preferred Brand/Generic																						2	4
H5526	008	0	1	04	01	H5526_008_0	6	2	3	Formulary Brand	000001	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5526	008	0	1	04	01	H5526_008_0	6	1	3	Formulary Generic	001000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00								1	4
H5526	008	0	1	04	01	H5526_008_0	6	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00									4
H5526	008	0	1	04	01	H5526_008_0	6	4	3	Specialty Injectibles	100001	1	1	Specialty Injectibles																							Specialty Injectibles					Specialty Injectibles																						Specialty Injectibles																						2	4
H5526	008	0	1	04	01	H5526_008_0	6	3	1	Non-Preferred Brand/Generic	100100	1	2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							4
H5526	008	0	1	04	01	H5526_008_0	6	4	1	Specialty Injectibles	100001	1	1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							4
H5527	001	0	1	04	01	H5527_001_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5527	001	0	1	04	01	H5527_001_0	8	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H5527	001	0	1	04	01	H5527_001_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5527	001	0	1	04	01	H5527_001_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H5528	002	0	1	04	01	H5528_002_0	3	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									3
H5528	002	0	1	04	01	H5528_002_0	3	2	1	Formulary Brand	000001		2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	30.00	90.00								30.00				60.00									3
H5528	002	0	1	04	01	H5528_002_0	3	4	1	Specialty	010010		1	Specialty	011000000010010000000	30	90								30			30									Specialty	2	1	011000000010010000000		Specialty	25	25								25			25									Specialty																							3
H5528	002	0	1	04	01	H5528_002_0	3	3	1	Non Preferred Brand	100000		2	Non Preferred Brand	011000000010001000000	30	90								30				90								Non Preferred Brand	2	2		011000000010001000000	Non Preferred Brand																						Non Preferred Brand	65.00	195.00								65.00				130.00									3
H5528	003	0	1	04	01	H5528_003_0	4	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									4
H5528	003	0	1	04	01	H5528_003_0	4	2	1	Formulary Brand	000001	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	29.00	87.00								29.00				58.00									4
H5528	003	0	1	04	01	H5528_003_0	4	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011000000010001000000	30	90								30				90								Non Preferred Brand	2	2		011000000010001000000	Non Preferred Brand																						Non Preferred Brand	56.00	168.00								56.00				112.00									4
H5528	003	0	1	04	01	H5528_003_0	4	4	1	Specialty	010010	1	1	Specialty	011000000010010000000	30	90								30			30									Specialty	2	1	011000000010010000000		Specialty	25	25								25			25									Specialty																							4
H5528	003	0	1	04	01	H5528_003_0	4	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00								1	4
H5528	003	0	1	04	01	H5528_003_0	4	2	3	Formulary Brand	000001	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5528	003	0	1	04	01	H5528_003_0	4	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5528	003	0	1	04	01	H5528_003_0	4	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand																							Non Preferred Brand					Non Preferred Brand																						Non Preferred Brand																						2	4
H5528	005	0	1	04	01	H5528_005_0	4	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									3
H5528	005	0	1	04	01	H5528_005_0	4	2	1	Formulary Brand	000001		2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	30.00	90.00								30.00				60.00									3
H5528	005	0	1	04	01	H5528_005_0	4	3	1	Non Preferred Brand	100000		2	Non Preferred Brand	011000000010001000000	30	90								30				90								Non Preferred Brand	2	2		011000000010001000000	Non Preferred Brand																						Non Preferred Brand	65.00	195.00								65.00				130.00									3
H5528	005	0	1	04	01	H5528_005_0	4	4	1	Specialty	010010		1	Specialty	011000000010010000000	30	90								30			30									Specialty	2	1	011000000010010000000		Specialty	25	25								25			25									Specialty																							3
H5528	008	0	1	04	01	H5528_008_0	5	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00								1	4
H5528	008	0	1	04	01	H5528_008_0	5	2	3	Formulary Brand	000001	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5528	008	0	1	04	01	H5528_008_0	5	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand																							Non Preferred Brand					Non Preferred Brand																						Non Preferred Brand																						2	4
H5528	008	0	1	04	01	H5528_008_0	5	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5528	008	0	1	04	01	H5528_008_0	5	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									4
H5528	008	0	1	04	01	H5528_008_0	5	2	1	Formulary Brand	000001	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	29.00	87.00								29.00				58.00									4
H5528	008	0	1	04	01	H5528_008_0	5	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011000000010001000000	30	90								30				90								Non Preferred Brand	2	2		011000000010001000000	Non Preferred Brand																						Non Preferred Brand	56.00	168.00								56.00				112.00									4
H5528	008	0	1	04	01	H5528_008_0	5	4	1	Specialty	010010	1	1	Specialty	011000000010010000000	30	90								30			30									Specialty	2	1	011000000010010000000		Specialty	25	25								25			25									Specialty																							4
H5528	010	0	1	04	01	H5528_010_0	5	3	1	Non Preferred Brand	100000		2	Non Preferred Brand	011000000010001000000	30	90								30				90								Non Preferred Brand	2	2		011000000010001000000	Non Preferred Brand																						Non Preferred Brand	65.00	195.00								65.00				130.00									3
H5528	010	0	1	04	01	H5528_010_0	5	2	1	Formulary Brand	000001		2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	30.00	90.00								30.00				60.00									3
H5528	010	0	1	04	01	H5528_010_0	5	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									3
H5528	010	0	1	04	01	H5528_010_0	5	4	1	Specialty	010010		1	Specialty	011000000010010000000	30	90								30			30									Specialty	2	1	011000000010010000000		Specialty	25	25								25			25									Specialty																							3
H5528	011	0	1	04	01	H5528_011_0	5	1	3	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00								1	4
H5528	011	0	1	04	01	H5528_011_0	5	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5528	011	0	1	04	01	H5528_011_0	5	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand																							Non Preferred Brand					Non Preferred Brand																						Non Preferred Brand																						2	4
H5528	011	0	1	04	01	H5528_011_0	5	4	1	Specialty	010010	1	1	Specialty	011000000010010000000	30	90								30			30									Specialty	2	1	011000000010010000000		Specialty	25	25								25			25									Specialty																							4
H5528	011	0	1	04	01	H5528_011_0	5	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011000000010001000000	30	90								30				90								Non Preferred Brand	2	2		011000000010001000000	Non Preferred Brand																						Non Preferred Brand	56.00	168.00								56.00				112.00									4
H5528	011	0	1	04	01	H5528_011_0	5	2	3	Formulary Brand	000001	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5528	011	0	1	04	01	H5528_011_0	5	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				20.00									4
H5528	011	0	1	04	01	H5528_011_0	5	2	1	Formulary Brand	000001	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	29.00	87.00								29.00				58.00									4
H5529	001	0	1	04	01	H5529_001_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H5529	001	0	1	04	01	H5529_001_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H5529	001	0	1	04	01	H5529_001_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5529	001	0	1	04	01	H5529_001_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5529	001	0	1	04	01	H5529_001_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00		1	4
H5529	001	0	1	04	01	H5529_001_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5529	001	0	1	04	01	H5529_001_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5529	001	0	1	04	01	H5529_001_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5529	001	0	1	04	01	H5529_001_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H5529	001	0	1	04	01	H5529_001_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H5529	002	0	1	04	01	H5529_002_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H5529	002	0	1	04	01	H5529_002_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5529	002	0	1	04	01	H5529_002_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5529	002	0	1	04	01	H5529_002_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00		1	4
H5529	002	0	1	04	01	H5529_002_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H5529	002	0	1	04	01	H5529_002_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5529	002	0	1	04	01	H5529_002_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5529	002	0	1	04	01	H5529_002_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			4
H5529	002	0	1	04	01	H5529_002_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00			4
H5529	002	0	1	04	01	H5529_002_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5530	001	0	1	04	01	H5530_001_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H5530	001	0	1	04	01	H5530_001_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5530	001	0	1	04	01	H5530_001_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5530	001	0	1	04	01	H5530_001_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00		1	4
H5530	001	0	1	04	01	H5530_001_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5530	001	0	1	04	01	H5530_001_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5530	001	0	1	04	01	H5530_001_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5530	001	0	1	04	01	H5530_001_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H5530	001	0	1	04	01	H5530_001_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
H5530	001	0	1	04	01	H5530_001_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H5530	002	0	1	04	01	H5530_002_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5530	002	0	1	04	01	H5530_002_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5530	002	0	1	04	01	H5530_002_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5530	002	0	1	04	01	H5530_002_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00		1	4
H5530	002	0	1	04	01	H5530_002_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00			4
H5530	002	0	1	04	01	H5530_002_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5530	002	0	1	04	01	H5530_002_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
H5530	002	0	1	04	01	H5530_002_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
H5530	002	0	1	04	01	H5530_002_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			4
H5530	002	0	1	04	01	H5530_002_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5531	001	0	1	04	01	H5531_001_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5531	001	0	1	04	01	H5531_001_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5531	001	0	1	04	01	H5531_001_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H5531	002	0	1	04	01	H5531_002_0	5	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5531	002	0	1	04	01	H5531_002_0	5	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5531	002	0	1	04	01	H5531_002_0	5	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5531	002	0	1	04	01	H5531_002_0	5	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5531	002	0	1	04	01	H5531_002_0	5	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H5531	002	0	1	04	01	H5531_002_0	5	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H5531	002	0	1	04	01	H5531_002_0	5	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5531	002	0	1	04	01	H5531_002_0	5	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5532	001	0	1	04	01	H5532_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H5532	001	0	1	04	01	H5532_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H5532	001	0	1	04	01	H5532_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H5532	001	0	1	04	01	H5532_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5533	002	0	1	04	01	H5533_002_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									4
H5533	002	0	1	04	01	H5533_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
H5533	002	0	1	04	01	H5533_002_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00				150.00									4
H5533	002	0	1	04	01	H5533_002_0	3	4	1	Low Cost Injectables	010010	1	2	Low Cost Injectables	011000000010001000000	31	90								31				90								Low Cost Injectables	2	1	011000000010001000000		Low Cost Injectables	25	25								25				25								Low Cost Injectables																							4
H5533	002	0	1	04	01	H5533_002_0	3	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5533	002	0	1	04	01	H5533_002_0	3	1	3	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00								1	4
H5533	002	0	1	04	01	H5533_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5533	002	0	1	04	01	H5533_002_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5533	002	0	1	04	01	H5533_002_0	3	4	3	Low Cost Injectables	010010	1	2	Low Cost Injectables																							Low Cost Injectables					Low Cost Injectables																						Low Cost Injectables																						2	4
H5533	002	0	1	04	01	H5533_002_0	3	5	1	Specialty	010010	1	1	Specialty	010000000010010000000	31									31			31									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H5575	002	0	1	01	01	H5575_002_0	20	2	1	Brand	000010	1	2	Brand	000010000010000000000				30						30												Brand	2	1	000010000010000000000		Brand				25						25												Brand																							4
H5575	002	0	1	01	01	H5575_002_0	20	1	1	Generic	010000	1	2	Generic	000010000010000000000				30						30												Generic	2	2		000010000010000000000	Generic																						Generic				5.00						5.00													4
H5575	002	0	1	01	01	H5575_002_0	20	1	3	Generic	010000	1	2	Generic	000010000010000000000				30						30												Generic	2	2		000010000010000000000	Generic																						Generic				5.00						5.00												1	4
H5575	002	0	1	01	01	H5575_002_0	20	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H5576	001	0	1	02	01	H5576_001_0	3	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00									3
H5576	001	0	1	02	01	H5576_001_0	3	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	32.00	96.00								32.00	96.00			96.00									3
H5576	001	0	1	02	01	H5576_001_0	3	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	64.00	192.00								64.00	192.00			192.00									3
H5576	001	0	1	02	01	H5576_001_0	3	4	1	Tier 4	100000		1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							3
H5576	002	0	1	02	01	H5576_002_0	3	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5576	002	0	1	02	01	H5576_002_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	32.00	96.00								32.00	96.00			96.00									4
H5576	002	0	1	02	01	H5576_002_0	3	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5576	002	0	1	02	01	H5576_002_0	3	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00								1	4
H5576	002	0	1	02	01	H5576_002_0	3	4	1	Tier 4	100000	1	1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							4
H5576	002	0	1	02	01	H5576_002_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	64.00	192.00								64.00	192.00			192.00									4
H5576	002	0	1	02	01	H5576_002_0	3	4	3	Tier 4	100000	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5576	002	0	1	02	01	H5576_002_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00									4
H5576	003	0	1	02	01	H5576_003_0	3	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	32.00	96.00								32.00	96.00			96.00									3
H5576	003	0	1	02	01	H5576_003_0	3	4	1	Tier 4	100000		1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							3
H5576	003	0	1	02	01	H5576_003_0	3	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	64.00	192.00								64.00	192.00			192.00									3
H5576	003	0	1	02	01	H5576_003_0	3	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00									3
H5576	004	0	1	02	01	H5576_004_0	3	4	3	Tier 4	100000	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5576	004	0	1	02	01	H5576_004_0	3	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5576	004	0	1	02	01	H5576_004_0	3	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5576	004	0	1	02	01	H5576_004_0	3	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00								1	4
H5576	004	0	1	02	01	H5576_004_0	3	4	1	Tier 4	100000	1	1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							4
H5576	004	0	1	02	01	H5576_004_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	64.00	192.00								64.00	192.00			192.00									4
H5576	004	0	1	02	01	H5576_004_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	32.00	96.00								32.00	96.00			96.00									4
H5576	004	0	1	02	01	H5576_004_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00									4
H5576	005	0	1	02	01	H5576_005_0	3	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	64.00	192.00								64.00	192.00			192.00									3
H5576	005	0	1	02	01	H5576_005_0	3	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	32.00	96.00								32.00	96.00			96.00									3
H5576	005	0	1	02	01	H5576_005_0	3	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00									3
H5576	005	0	1	02	01	H5576_005_0	3	4	1	Tier 4	100000		1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							3
H5576	006	0	1	02	01	H5576_006_0	3	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5576	006	0	1	02	01	H5576_006_0	3	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5576	006	0	1	02	01	H5576_006_0	3	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00								1	4
H5576	006	0	1	02	01	H5576_006_0	3	4	1	Tier 4	100000	1	1	Tier 4	011000000011001000000	31	90								31	90			90								Tier 4	2	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							4
H5576	006	0	1	02	01	H5576_006_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	31	90								31	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	64.00	192.00								64.00	192.00			192.00									4
H5576	006	0	1	02	01	H5576_006_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	31	90								31	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	32.00	96.00								32.00	96.00			96.00									4
H5576	006	0	1	02	01	H5576_006_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	31	90								31	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	6.00	18.00								6.00	18.00			18.00									4
H5576	006	0	1	02	01	H5576_006_0	3	4	3	Tier 4	100000	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5577	001	0	1	01	01	H5577_001_0	7	1	1	Formulary Generic	011000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	1	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	16.00								8.00				16.00									4
H5577	001	0	1	01	01	H5577_001_0	7	2	1	Formulary Preferred Brand	001001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	1	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	15.00	30.00								15.00				30.00									4
H5577	001	0	1	01	01	H5577_001_0	7	3	1	Formulary Non-Preferred	100000	1	2	Formulary Non-Preferred	011000000010001000000	30	90								30				90								Formulary Non-Preferred	1	2		011000000010001000000	Formulary Non-Preferred																						Formulary Non-Preferred	40.00	80.00								40.00				80.00									4
H5577	001	0	1	01	01	H5577_001_0	7	4	1	Formulary High Cost	000001	1	1	Formulary High Cost	011000000010001000000	30	90								30				90								Formulary High Cost	1	1	011000000010001000000		Formulary High Cost	20	20								20				20								Formulary High Cost																							4
H5578	002	0	1	01	01	H5578_002_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5578	002	0	1	01	01	H5578_002_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5578	002	0	1	01	01	H5578_002_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5578	002	0	1	01	01	H5578_002_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5578	002	0	1	01	01	H5578_002_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5578	002	0	1	01	01	H5578_002_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5578	002	0	1	01	01	H5578_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5578	002	0	1	01	01	H5578_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5578	003	0	1	01	01	H5578_003_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5578	003	0	1	01	01	H5578_003_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5578	003	0	1	01	01	H5578_003_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5578	003	0	1	01	01	H5578_003_0	7	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5578	003	0	1	01	01	H5578_003_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5578	003	0	1	01	01	H5578_003_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5578	003	0	1	01	01	H5578_003_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5578	003	0	1	01	01	H5578_003_0	7	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5586	001	0	1	01	01	H5586_001_0	4	1	1	Generic	010000	3	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									4
H5586	001	0	1	01	01	H5586_001_0	4	3	1	Non-Formulary Brand	100000	3	2	Non-Formulary Brand	011000000011001000000	30	90								30	90			90								Non-Formulary Brand	2	2		011000000011001000000	Non-Formulary Brand																						Non-Formulary Brand	50.00	100.00								50.00	100.00			100.00									4
H5586	001	0	1	01	01	H5586_001_0	4	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	25.00	50.00								25.00	50.00			50.00									4
H5591	001	0	1	01	01	H5591_001_0	6	1	1	Tier I Generic	010000		2	Tier I Generic	011000000010011000000	30	90								30			30	90								Tier I Generic	2	2		011000000010011000000	Tier I Generic																						Tier I Generic	5.00	15.00								5.00			5.00	12.50									3
H5591	001	0	1	01	01	H5591_001_0	6	2	1	Tier 2  Brand	000001		2	Tier 2  Brand	011000000010011000000	30	90								30			30	90								Tier 2  Brand	2	2		011000000010011000000	Tier 2  Brand																						Tier 2  Brand	35.00	105.00								35.00			35.00	87.50									3
H5591	001	0	1	01	01	H5591_001_0	6	3	1	Tier 3 Non-Preferred Brand	100000		2	Tier 3 Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Tier 3 Non-Preferred Brand	2	2		011000000010011000000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	55.00	165.00								55.00			55.00	137.50									3
H5591	001	0	1	01	01	H5591_001_0	6	4	1	Tier 4 Specialty	010010		1	Tier 4 Specialty	011000000010011000000	30	90								30			30	90								Tier 4 Specialty	2	1	011000000010011000000		Tier 4 Specialty	25	25								25			25	25								Tier 4 Specialty																							3
H5594	001	0	1	01	01	H5594_001_0	5	1	3	Generic	010000	1	2	Generic	011100000011100000000	31	90	60							31	90	60										Generic	2	2		011100000011100000000	Generic																						Generic	5.00	15.00	10.00							5.00	15.00	10.00										1	4
H5594	001	0	1	01	01	H5594_001_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5594	001	0	1	01	01	H5594_001_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5594	001	0	1	01	01	H5594_001_0	5	4	1	Specialty - Generic & Brand	010010	3	1	Specialty - Generic & Brand	011100000011100000000	31	90	60							31	90	60										Specialty - Generic & Brand	2	1	011100000011100000000		Specialty - Generic & Brand	25	25	25							25	25	25										Specialty - Generic & Brand																							4
H5594	001	0	1	01	01	H5594_001_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011100000011100000000	31	90	60							31	90	60										Non-Preferred Brand	2	2		011100000011100000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00	80.00							40.00	120.00	80.00											4
H5594	001	0	1	01	01	H5594_001_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011100000000	31	90	60							31	90	60										Preferred Brand	2	2		011100000011100000000	Preferred Brand																						Preferred Brand	20.00	60.00	40.00							20.00	60.00	40.00											4
H5594	001	0	1	01	01	H5594_001_0	5	1	1	Generic	010000	1	2	Generic	011100000011100000000	31	90	60							31	90	60										Generic	2	2		011100000011100000000	Generic																						Generic	5.00	15.00	10.00							5.00	15.00	10.00											4
H5594	001	0	1	01	01	H5594_001_0	5	4	3	Specialty - Generic & Brand	010010	3	1	Specialty - Generic & Brand																							Specialty - Generic & Brand					Specialty - Generic & Brand																						Specialty - Generic & Brand																						2	4
H5594	002	0	1	01	01	H5594_002_0	5	1	1	Generic	010000	1	2	Generic	011100000011100000000	31	90	60							31	90	60										Generic	2	2		011100000011100000000	Generic																						Generic	0.00	0.00	0.00							0.00	0.00	0.00											4
H5594	002	0	1	01	01	H5594_002_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011100000000	31	90	60							31	90	60										Preferred Brand	2	2		011100000011100000000	Preferred Brand																						Preferred Brand	15.00	45.00	30.00							15.00	45.00	30.00											4
H5594	002	0	1	01	01	H5594_002_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011100000011100000000	31	90	60							31	90	60										Non-Preferred Brand	2	2		011100000011100000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00											4
H5594	002	0	1	01	01	H5594_002_0	5	4	1	Specialty - Generic & Brand	010010	3	1	Specialty - Generic & Brand	011100000011100000000	31	90	60							31	90	60										Specialty - Generic & Brand	2	1	011100000011100000000		Specialty - Generic & Brand	25	25	25							25	25	25										Specialty - Generic & Brand																							4
H5594	002	0	1	01	01	H5594_002_0	5	1	3	Generic	010000	1	2	Generic	011100000011100000000	31	90	60							31	90	60										Generic	2	2		011100000011100000000	Generic																						Generic	0.00	0.00	0.00							0.00	0.00	0.00										1	4
H5594	002	0	1	01	01	H5594_002_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand	011100000011100000000	31	90	60							31	90	60										Preferred Brand	2	2		011100000011100000000	Preferred Brand																						Preferred Brand	15.00	45.00	30.00							15.00	45.00	30.00										1	4
H5594	002	0	1	01	01	H5594_002_0	5	4	3	Specialty - Generic & Brand	010010	3	1	Specialty - Generic & Brand	011100000011100000000	31	90	60							31	90	60										Specialty - Generic & Brand	2	1	011100000011100000000		Specialty - Generic & Brand	25	25	25							25	25	25										Specialty - Generic & Brand																						1	4
H5594	002	0	1	01	01	H5594_002_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011100000011100000000	31	90	60							31	90	60										Non-Preferred Brand	2	2		011100000011100000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00										1	4
H5598	001	0	1	39	05	H5598_001_0	6	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H5598	001	0	1	39	05	H5598_001_0	6	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H5598	001	0	1	39	05	H5598_001_0	6	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H5598	001	0	1	39	05	H5598_001_0	6	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H5604	003	0	1	02	01	H5604_003_0	3	1	1	Generic	010000	1	2	Generic	000011000011011000000				30	90					30	90		30	90								Generic	2	2		000011000011011000000	Generic																						Generic				5.00	10.00					5.00	10.00		5.00	10.00									4
H5604	003	0	1	02	01	H5604_003_0	3	2	1	Select Brand	000001	1	2	Select Brand	000011000011011000000				30	90					30	90		30	90								Select Brand	2	2		000011000011011000000	Select Brand																						Select Brand				10.00	20.00					10.00	20.00		10.00	20.00									4
H5604	003	0	1	02	01	H5604_003_0	3	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5604	003	0	1	02	01	H5604_003_0	3	4	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5604	003	0	1	02	01	H5604_003_0	3	3	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5604	003	0	1	02	01	H5604_003_0	3	2	3	Select Brand	000001	1	2	Select Brand																							Select Brand					Select Brand																						Select Brand																						2	4
H5604	003	0	1	02	01	H5604_003_0	3	1	3	Generic	010000	1	2	Generic	000011000011011000000				30	90					30	90		30	90								Generic	2	2		000011000011011000000	Generic																						Generic				5.00	10.00					5.00	10.00		5.00	10.00								1	4
H5604	003	0	1	02	01	H5604_003_0	3	5	1	Specialty	010010	1	1	Specialty	000011000011011000000				30	90					30	90		30	90								Specialty	2	1	000011000011011000000		Specialty				25	25					25	25		25	25								Specialty																							4
H5604	003	0	1	02	01	H5604_003_0	3	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011000011011000000				30	90					30	90		30	90								Non-Preferred Brand	2	2		000011000011011000000	Non-Preferred Brand																						Non-Preferred Brand				40.00	90.00					40.00	90.00		40.00	90.00									4
H5604	003	0	1	02	01	H5604_003_0	3	3	1	Preferred Brand	000001	1	2	Preferred Brand	000011000011011000000				30	90					30	90		30	90								Preferred Brand	2	2		000011000011011000000	Preferred Brand																						Preferred Brand				25.00	60.00					25.00	60.00		25.00	60.00									4
H5609	001	0	1	01	01	H5609_001_0	4	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5609	001	0	1	01	01	H5609_001_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5609	001	0	1	01	01	H5609_001_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5609	001	0	1	01	01	H5609_001_0	4	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00								1	4
H5609	001	0	1	01	01	H5609_001_0	4	4	3	Injectable	010010	1	1	Injectable																							Injectable					Injectable																						Injectable																						2	4
H5609	001	0	1	01	01	H5609_001_0	4	4	1	Injectable	010010	1	1	Injectable	011000000011001000000	30	90								30	90			90								Injectable	2	1	011000000011001000000		Injectable	25	25								25	25			25								Injectable																							4
H5609	001	0	1	01	01	H5609_001_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	25.00	75.00								25.00	75.00			50.00									4
H5609	001	0	1	01	01	H5609_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00			40.00									4
H5609	001	0	1	01	01	H5609_001_0	4	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00									4
H5609	001	0	1	01	01	H5609_001_0	4	5	1	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							4
H5611	001	0	1	01	01	H5611_001_0	6	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5611	001	0	1	01	01	H5611_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H5611	001	0	1	01	01	H5611_001_0	6	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5611	001	0	1	01	01	H5611_001_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5611	001	0	1	01	01	H5611_001_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5611	001	0	1	01	01	H5611_001_0	6	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5611	001	0	1	01	01	H5611_001_0	6	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5611	001	0	1	01	01	H5611_001_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00			60.00	180.00									4
H5611	004	0	1	01	01	H5611_004_0	5	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5611	004	0	1	01	01	H5611_004_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5611	004	0	1	01	01	H5611_004_0	5	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5611	004	0	1	01	01	H5611_004_0	5	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
H5611	004	0	1	01	01	H5611_004_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5611	004	0	1	01	01	H5611_004_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H5611	004	0	1	01	01	H5611_004_0	5	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5611	004	0	1	01	01	H5611_004_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5611	005	0	1	01	01	H5611_005_0	4	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5611	005	0	1	01	01	H5611_005_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5611	005	0	1	01	01	H5611_005_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5611	005	0	1	01	01	H5611_005_0	4	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5611	005	0	1	01	01	H5611_005_0	4	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
H5611	005	0	1	01	01	H5611_005_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5611	005	0	1	01	01	H5611_005_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H5611	005	0	1	01	01	H5611_005_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5611	007	0	1	01	01	H5611_007_0	6	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5611	007	0	1	01	01	H5611_007_0	6	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5611	007	0	1	01	01	H5611_007_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5611	007	0	1	01	01	H5611_007_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5611	007	0	1	01	01	H5611_007_0	6	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5611	007	0	1	01	01	H5611_007_0	6	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5611	007	0	1	01	01	H5611_007_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	210.00								70.00			70.00	210.00									4
H5611	007	0	1	01	01	H5611_007_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5611	008	0	1	01	01	H5611_008_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5611	008	0	1	01	01	H5611_008_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5611	008	0	1	01	01	H5611_008_0	5	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5611	008	0	1	01	01	H5611_008_0	5	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5611	008	0	1	01	01	H5611_008_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	210.00								70.00			70.00	210.00									4
H5611	008	0	1	01	01	H5611_008_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5611	008	0	1	01	01	H5611_008_0	5	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5611	008	0	1	01	01	H5611_008_0	5	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5611	012	0	1	01	01	H5611_012_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5611	012	0	1	01	01	H5611_012_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5611	012	0	1	01	01	H5611_012_0	7	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5611	012	0	1	01	01	H5611_012_0	7	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5611	012	0	1	01	01	H5611_012_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5611	012	0	1	01	01	H5611_012_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00			15.00	45.00									4
H5611	012	0	1	01	01	H5611_012_0	7	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5611	012	0	1	01	01	H5611_012_0	7	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5619	001	0	1	01	01	H5619_001_0	12	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5619	001	0	1	01	01	H5619_001_0	12	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5619	001	0	1	01	01	H5619_001_0	12	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5619	001	0	1	01	01	H5619_001_0	12	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5619	001	0	1	01	01	H5619_001_0	12	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5619	001	0	1	01	01	H5619_001_0	12	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5619	001	0	1	01	01	H5619_001_0	12	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5619	001	0	1	01	01	H5619_001_0	12	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5619	002	0	1	01	01	H5619_002_0	10	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5619	002	0	1	01	01	H5619_002_0	10	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5619	002	0	1	01	01	H5619_002_0	10	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5619	002	0	1	01	01	H5619_002_0	10	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5619	002	0	1	01	01	H5619_002_0	10	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5619	002	0	1	01	01	H5619_002_0	10	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5619	002	0	1	01	01	H5619_002_0	10	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5619	002	0	1	01	01	H5619_002_0	10	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5649	001	0	1	01	01	H5649_001_0	4	2	1	Tier Two	000010	1	2	Tier Two	000011010010011000000				30	90		30			30			30	90								Tier Two	2	2		000011010010011000000	Tier Two																						Tier Two				25.00	75.00		25.00			25.00			25.00	75.00									4
H5649	001	0	1	01	01	H5649_001_0	4	1	1	Tier One	010000	1	2	Tier One	000011010010011000000				30	90		30			30			30	90								Tier One	2	2		000011010010011000000	Tier One																						Tier One				5.00	15.00		5.00			5.00			5.00	15.00									4
H5652	001	0	1	37	05	H5652_001_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5652	001	0	1	37	05	H5652_001_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5652	001	0	1	37	05	H5652_001_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5652	001	0	1	37	05	H5652_001_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5652	003	0	1	37	05	H5652_003_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5652	003	0	1	37	05	H5652_003_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5652	003	0	1	37	05	H5652_003_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5652	003	0	1	37	05	H5652_003_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5652	004	0	1	37	05	H5652_004_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5652	004	0	1	37	05	H5652_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5652	004	0	1	37	05	H5652_004_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5652	004	0	1	37	05	H5652_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5656	001	0	1	01	01	H5656_001_0	5	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5656	001	0	1	01	01	H5656_001_0	5	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00								1	4
H5656	001	0	1	01	01	H5656_001_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5656	001	0	1	01	01	H5656_001_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H5656	001	0	1	01	01	H5656_001_0	5	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H5656	001	0	1	01	01	H5656_001_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5656	001	0	1	01	01	H5656_001_0	5	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5656	001	0	1	01	01	H5656_001_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H5656	002	0	1	01	01	H5656_002_0	3	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H5656	002	0	1	01	01	H5656_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H5656	002	0	1	01	01	H5656_002_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5656	002	0	1	01	01	H5656_002_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5656	002	0	1	01	01	H5656_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5656	002	0	1	01	01	H5656_002_0	3	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00								1	4
H5656	002	0	1	01	01	H5656_002_0	3	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5656	002	0	1	01	01	H5656_002_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H5656	004	0	1	01	01	H5656_004_0	4	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H5656	004	0	1	01	01	H5656_004_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H5656	004	0	1	01	01	H5656_004_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5656	004	0	1	01	01	H5656_004_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5656	004	0	1	01	01	H5656_004_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5656	004	0	1	01	01	H5656_004_0	4	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00								1	4
H5656	004	0	1	01	01	H5656_004_0	4	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5656	004	0	1	01	01	H5656_004_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H5657	004	0	1	09	04	H5657_004_0	4	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H5657	004	0	1	09	04	H5657_004_0	4	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H5657	004	0	1	09	04	H5657_004_0	4	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H5657	004	0	1	09	04	H5657_004_0	4	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H5657	005	0	1	09	04	H5657_005_0	7	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00			4.00	10.00									4
H5657	005	0	1	09	04	H5657_005_0	7	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
H5657	005	0	1	09	04	H5657_005_0	7	3	1	Other-Non-Preferred	100100	1	2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
H5657	005	0	1	09	04	H5657_005_0	7	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
H5665	001	0	1	01	01	H5665_001_0	10	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
H5665	001	0	1	01	01	H5665_001_0	10	3	1	Formulary Non-Preferred Brand	100000		2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	50.00	150.00								50.00				150.00									3
H5665	001	0	1	01	01	H5665_001_0	10	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	38.00	114.00								38.00				114.00									3
H5665	001	0	1	01	01	H5665_001_0	10	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00				0.00									3
H5665	002	0	1	01	01	H5665_002_0	10	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									3
H5665	002	0	1	01	01	H5665_002_0	10	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	26.00	78.00								26.00				78.00									3
H5665	002	0	1	01	01	H5665_002_0	10	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
H5665	002	0	1	01	01	H5665_002_0	10	3	1	Formulary Non-Preferred Brand	100000		2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									3
H5665	003	0	1	01	01	H5665_003_0	10	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									3
H5665	003	0	1	01	01	H5665_003_0	10	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	26.00	78.00								26.00				78.00									3
H5665	003	0	1	01	01	H5665_003_0	10	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
H5665	003	0	1	01	01	H5665_003_0	10	3	1	Formulary Non-Preferred Brand	100000		2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									3
H5665	004	0	1	01	01	H5665_004_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
H5665	004	0	1	01	01	H5665_004_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	26.00	78.00								26.00				78.00									4
H5665	004	0	1	01	01	H5665_004_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									4
H5665	004	0	1	01	01	H5665_004_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
H5665	004	0	1	01	01	H5665_004_0	10	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
H5665	004	0	1	01	01	H5665_004_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00								1	4
H5665	004	0	1	01	01	H5665_004_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5665	004	0	1	01	01	H5665_004_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
H5665	004	0	1	01	01	H5665_004_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H5665	004	0	1	01	01	H5665_004_0	10	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
H5665	005	0	1	01	01	H5665_005_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
H5665	005	0	1	01	01	H5665_005_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									4
H5665	005	0	1	01	01	H5665_005_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	26.00	78.00								26.00				78.00									4
H5665	005	0	1	01	01	H5665_005_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
H5665	005	0	1	01	01	H5665_005_0	10	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
H5665	005	0	1	01	01	H5665_005_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic																							Formulary Generic					Formulary Generic																						Formulary Generic																						2	4
H5665	005	0	1	01	01	H5665_005_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5665	005	0	1	01	01	H5665_005_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
H5665	005	0	1	01	01	H5665_005_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H5665	005	0	1	01	01	H5665_005_0	10	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
H5665	006	0	1	01	01	H5665_006_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
H5665	006	0	1	01	01	H5665_006_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									4
H5665	006	0	1	01	01	H5665_006_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	26.00	78.00								26.00				78.00									4
H5665	006	0	1	01	01	H5665_006_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
H5665	006	0	1	01	01	H5665_006_0	10	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
H5665	006	0	1	01	01	H5665_006_0	10	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
H5665	006	0	1	01	01	H5665_006_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H5665	006	0	1	01	01	H5665_006_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
H5665	006	0	1	01	01	H5665_006_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5665	006	0	1	01	01	H5665_006_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic																							Formulary Generic					Formulary Generic																						Formulary Generic																						2	4
H5665	007	0	1	01	01	H5665_007_0	11	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
H5665	007	0	1	01	01	H5665_007_0	11	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	26.00	78.00								26.00				78.00									4
H5665	007	0	1	01	01	H5665_007_0	11	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									4
H5665	007	0	1	01	01	H5665_007_0	11	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
H5665	007	0	1	01	01	H5665_007_0	11	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
H5665	007	0	1	01	01	H5665_007_0	11	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
H5665	007	0	1	01	01	H5665_007_0	11	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5665	007	0	1	01	01	H5665_007_0	11	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00								1	4
H5665	007	0	1	01	01	H5665_007_0	11	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
H5665	007	0	1	01	01	H5665_007_0	11	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H5678	001	0	1	37	05	H5678_001_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5678	001	0	1	37	05	H5678_001_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5678	001	0	1	37	05	H5678_001_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5678	001	0	1	37	05	H5678_001_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5678	003	0	1	37	05	H5678_003_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5678	003	0	1	37	05	H5678_003_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5678	003	0	1	37	05	H5678_003_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5678	003	0	1	37	05	H5678_003_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5678	004	0	1	37	05	H5678_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5678	004	0	1	37	05	H5678_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5678	004	0	1	37	05	H5678_004_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5678	004	0	1	37	05	H5678_004_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5679	001	0	1	01	01	H5679_001_0	8	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
H5679	001	0	1	01	01	H5679_001_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
H5679	001	0	1	01	01	H5679_001_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
H5679	001	0	1	01	01	H5679_001_0	8	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
H5679	001	0	1	01	01	H5679_001_0	8	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
H5685	001	0	1	01	01	H5685_001_0	6	2	1	Tier Two Brand	000010		2	Tier Two Brand	010000000010000000000	30									30												Tier Two Brand	2	2		010000000010000000000	Tier Two Brand																						Tier Two Brand	43.00									43.00													3
H5685	001	0	1	01	01	H5685_001_0	6	1	1	Tier One Generic	010000		2	Tier One Generic	010000000010000000000	30									30												Tier One Generic	2	2		010000000010000000000	Tier One Generic																						Tier One Generic	0.00									0.00													3
H5696	001	0	1	01	01	H5696_001_0	4	2	3	Non-Preferred Generic	010100	1	2	Non-Preferred Generic	011000000010001000000	30	90								30				90								Non-Preferred Generic	2	2		011000000010001000000	Non-Preferred Generic																						Non-Preferred Generic	10.00	30.00								10.00				0.00								1	4
H5696	001	0	1	01	01	H5696_001_0	4	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				0.00								1	4
H5696	001	0	1	01	01	H5696_001_0	4	6	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5696	001	0	1	01	01	H5696_001_0	4	5	3	Injectable	010010	1	2	Injectable																							Injectable					Injectable																						Injectable																						2	4
H5696	001	0	1	01	01	H5696_001_0	4	4	3	Non-Preferred Brand	100010	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5696	001	0	1	01	01	H5696_001_0	4	3	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5696	001	0	1	01	01	H5696_001_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				0.00									4
H5696	001	0	1	01	01	H5696_001_0	4	6	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							4
H5696	001	0	1	01	01	H5696_001_0	4	5	1	Injectable	010010	1	2	Injectable	011000000010001000000	30	90								30				90								Injectable	2	1	011000000010001000000		Injectable	25	25								25				25								Injectable																							4
H5696	001	0	1	01	01	H5696_001_0	4	4	1	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00				80.00									4
H5696	001	0	1	01	01	H5696_001_0	4	3	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									4
H5696	001	0	1	01	01	H5696_001_0	4	2	1	Non-Preferred Generic	010100	1	2	Non-Preferred Generic	011000000010001000000	30	90								30				90								Non-Preferred Generic	2	2		011000000010001000000	Non-Preferred Generic																						Non-Preferred Generic	10.00	30.00								10.00				0.00									4
H5696	002	0	1	01	01	H5696_002_0	5	5	1	Injectable	010010	1	2	Injectable	011000000010001000000	30	90								30				90								Injectable	2	1	011000000010001000000		Injectable	25	25								25				25								Injectable																							4
H5696	002	0	1	01	01	H5696_002_0	5	4	1	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00				100.00									4
H5696	002	0	1	01	01	H5696_002_0	5	3	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00				80.00									4
H5696	002	0	1	01	01	H5696_002_0	5	2	1	Non-Preferred Generic	010100	1	2	Non-Preferred Generic	011000000010001000000	30	90								30				90								Non-Preferred Generic	2	2		011000000010001000000	Non-Preferred Generic																						Non-Preferred Generic	13.00	39.00								13.00				26.00									4
H5696	002	0	1	01	01	H5696_002_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	13.00	39.00								13.00				26.00									4
H5696	002	0	1	01	01	H5696_002_0	5	6	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							4
H5696	003	0	1	01	01	H5696_003_0	6	2	3	Non-Preferred Generic	010100	1	2	Non-Preferred Generic	011000000010001000000	30	90								30				90								Non-Preferred Generic	2	2		011000000010001000000	Non-Preferred Generic																						Non-Preferred Generic	10.00	30.00								10.00				0.00								1	4
H5696	003	0	1	01	01	H5696_003_0	6	1	3	Generic	001000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				0.00								1	4
H5696	003	0	1	01	01	H5696_003_0	6	6	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							4
H5696	003	0	1	01	01	H5696_003_0	6	5	1	Injectable	010010	1	2	Injectable	011000000010001000000	30	90								30				90								Injectable	2	1	011000000010001000000		Injectable	25	25								25				25								Injectable																							4
H5696	003	0	1	01	01	H5696_003_0	6	4	1	Non-Preferred Brand	100010	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00				100.00									4
H5696	003	0	1	01	01	H5696_003_0	6	3	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00				70.00									4
H5696	003	0	1	01	01	H5696_003_0	6	2	1	Non-Preferred Generic	010100	1	2	Non-Preferred Generic	011000000010001000000	30	90								30				90								Non-Preferred Generic	2	2		011000000010001000000	Non-Preferred Generic																						Non-Preferred Generic	10.00	30.00								10.00				0.00									4
H5696	003	0	1	01	01	H5696_003_0	6	1	1	Generic	001000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	30.00								10.00				0.00									4
H5696	003	0	1	01	01	H5696_003_0	6	3	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5696	003	0	1	01	01	H5696_003_0	6	6	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5696	003	0	1	01	01	H5696_003_0	6	5	3	Injectable	010010	1	2	Injectable																							Injectable					Injectable																						Injectable																						2	4
H5696	003	0	1	01	01	H5696_003_0	6	4	3	Non-Preferred Brand	100010	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5696	004	0	1	01	01	H5696_004_0	7	5	1	Injectable	010010	1	2	Injectable	011000000010001000000	30	90								30				90								Injectable	2	1	011000000010001000000		Injectable	25	25								25				25								Injectable																							4
H5696	004	0	1	01	01	H5696_004_0	7	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00				100.00									4
H5696	004	0	1	01	01	H5696_004_0	7	3	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00				80.00									4
H5696	004	0	1	01	01	H5696_004_0	7	2	1	Non-Preferred Generic	010100	1	2	Non-Preferred Generic	011000000010001000000	30	90								30				90								Non-Preferred Generic	2	2		011000000010001000000	Non-Preferred Generic																						Non-Preferred Generic	13.00	39.00								13.00				26.00									4
H5696	004	0	1	01	01	H5696_004_0	7	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	13.00	39.00								13.00				26.00									4
H5696	004	0	1	01	01	H5696_004_0	7	6	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							4
H5696	005	0	1	01	01	H5696_005_0	5	5	1	Injectable	010010	1	2	Injectable	011000000010001000000	30	90								30				90								Injectable	2	1	011000000010001000000		Injectable	25	25								25				25								Injectable																							4
H5696	005	0	1	01	01	H5696_005_0	5	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	75.00	225.00								75.00				150.00									4
H5696	005	0	1	01	01	H5696_005_0	5	3	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00				80.00									4
H5696	005	0	1	01	01	H5696_005_0	5	2	1	Non-Preferred Generic	010100	1	2	Non-Preferred Generic	011000000010001000000	30	90								30				90								Non-Preferred Generic	2	2		011000000010001000000	Non-Preferred Generic																						Non-Preferred Generic	5.00	15.00								5.00				0.00									4
H5696	005	0	1	01	01	H5696_005_0	5	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				0.00									4
H5696	005	0	1	01	01	H5696_005_0	5	6	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							4
H5696	005	0	1	01	01	H5696_005_0	5	6	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5696	005	0	1	01	01	H5696_005_0	5	5	3	Injectable	010010	1	2	Injectable																							Injectable					Injectable																						Injectable																						2	4
H5696	005	0	1	01	01	H5696_005_0	5	4	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5696	005	0	1	01	01	H5696_005_0	5	3	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5696	005	0	1	01	01	H5696_005_0	5	2	3	Non-Preferred Generic	010100	1	2	Non-Preferred Generic	011000000010001000000	30	90								30				90								Non-Preferred Generic	2	2		011000000010001000000	Non-Preferred Generic																						Non-Preferred Generic	5.00	15.00								5.00				0.00								1	4
H5696	005	0	1	01	01	H5696_005_0	5	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				0.00								1	4
H5696	006	0	1	01	01	H5696_006_0	8	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00				100.00									4
H5696	006	0	1	01	01	H5696_006_0	8	5	1	Injectable	010010	1	2	Injectable	011000000010001000000	30	90								30				90								Injectable	2	1	011000000010001000000		Injectable	25	25								25				25								Injectable																							4
H5696	006	0	1	01	01	H5696_006_0	8	2	1	Non-Preferred Generic	010100	1	2	Non-Preferred Generic	011000000010001000000	30	90								30				90								Non-Preferred Generic	2	2		011000000010001000000	Non-Preferred Generic																						Non-Preferred Generic	13.00	39.00								13.00				26.00									4
H5696	006	0	1	01	01	H5696_006_0	8	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	13.00	39.00								13.00				26.00									4
H5696	006	0	1	01	01	H5696_006_0	8	3	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00				80.00									4
H5696	006	0	1	01	01	H5696_006_0	8	6	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							4
H5697	001	0	1	37	05	H5697_001_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5697	001	0	1	37	05	H5697_001_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5697	001	0	1	37	05	H5697_001_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5697	001	0	1	37	05	H5697_001_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5697	003	0	1	37	05	H5697_003_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5697	003	0	1	37	05	H5697_003_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5697	003	0	1	37	05	H5697_003_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5697	003	0	1	37	05	H5697_003_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5698	002	0	1	01	01	H5698_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
H5698	002	0	1	01	01	H5698_002_0	4	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	002	0	1	01	01	H5698_002_0	4	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	002	0	1	01	01	H5698_002_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	002	0	1	01	01	H5698_002_0	4	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00							1	4
H5698	002	0	1	01	01	H5698_002_0	4	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	002	0	1	01	01	H5698_002_0	4	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	002	0	1	01	01	H5698_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	005	0	1	01	01	H5698_005_0	5	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
H5698	005	0	1	01	01	H5698_005_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	005	0	1	01	01	H5698_005_0	5	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	005	0	1	01	01	H5698_005_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	005	0	1	01	01	H5698_005_0	5	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00							1	4
H5698	005	0	1	01	01	H5698_005_0	5	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	005	0	1	01	01	H5698_005_0	5	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	005	0	1	01	01	H5698_005_0	5	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	012	0	1	01	01	H5698_012_0	4	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00								4
H5698	012	0	1	01	01	H5698_012_0	4	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	012	0	1	01	01	H5698_012_0	4	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	012	0	1	01	01	H5698_012_0	4	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	012	0	1	01	01	H5698_012_0	4	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00							1	4
H5698	012	0	1	01	01	H5698_012_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	012	0	1	01	01	H5698_012_0	4	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	012	0	1	01	01	H5698_012_0	4	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	013	0	1	01	01	H5698_013_0	5	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	013	0	1	01	01	H5698_013_0	5	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	013	0	1	01	01	H5698_013_0	5	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
H5698	013	0	1	01	01	H5698_013_0	5	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	013	0	1	01	01	H5698_013_0	5	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00							1	4
H5698	013	0	1	01	01	H5698_013_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	013	0	1	01	01	H5698_013_0	5	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	013	0	1	01	01	H5698_013_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	017	0	1	01	01	H5698_017_0	4	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	017	0	1	01	01	H5698_017_0	4	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	017	0	1	01	01	H5698_017_0	4	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00								4
H5698	017	0	1	01	01	H5698_017_0	4	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	017	0	1	01	01	H5698_017_0	4	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	017	0	1	01	01	H5698_017_0	4	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	017	0	1	01	01	H5698_017_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	017	0	1	01	01	H5698_017_0	4	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00							1	4
H5698	018	0	1	01	01	H5698_018_0	4	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00								4
H5698	018	0	1	01	01	H5698_018_0	4	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	018	0	1	01	01	H5698_018_0	4	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	018	0	1	01	01	H5698_018_0	4	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	018	0	1	01	01	H5698_018_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	018	0	1	01	01	H5698_018_0	4	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00							1	4
H5698	018	0	1	01	01	H5698_018_0	4	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	018	0	1	01	01	H5698_018_0	4	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	020	0	1	01	01	H5698_020_0	5	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
H5698	020	0	1	01	01	H5698_020_0	5	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	020	0	1	01	01	H5698_020_0	5	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	020	0	1	01	01	H5698_020_0	5	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	020	0	1	01	01	H5698_020_0	5	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00							1	4
H5698	020	0	1	01	01	H5698_020_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	020	0	1	01	01	H5698_020_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	020	0	1	01	01	H5698_020_0	5	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	021	0	1	01	01	H5698_021_0	4	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	021	0	1	01	01	H5698_021_0	4	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	021	0	1	01	01	H5698_021_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	021	0	1	01	01	H5698_021_0	4	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00							1	4
H5698	021	0	1	01	01	H5698_021_0	4	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	021	0	1	01	01	H5698_021_0	4	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	021	0	1	01	01	H5698_021_0	4	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	021	0	1	01	01	H5698_021_0	4	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00								4
H5698	028	0	1	01	01	H5698_028_0	5	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
H5698	028	0	1	01	01	H5698_028_0	5	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	028	0	1	01	01	H5698_028_0	5	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	028	0	1	01	01	H5698_028_0	5	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	028	0	1	01	01	H5698_028_0	5	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00							1	4
H5698	028	0	1	01	01	H5698_028_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	028	0	1	01	01	H5698_028_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	028	0	1	01	01	H5698_028_0	5	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	029	0	1	01	01	H5698_029_0	4	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	029	0	1	01	01	H5698_029_0	4	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	029	0	1	01	01	H5698_029_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	029	0	1	01	01	H5698_029_0	4	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00							1	4
H5698	029	0	1	01	01	H5698_029_0	4	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	029	0	1	01	01	H5698_029_0	4	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	029	0	1	01	01	H5698_029_0	4	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	029	0	1	01	01	H5698_029_0	4	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00								4
H5698	036	0	1	01	01	H5698_036_0	5	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
H5698	036	0	1	01	01	H5698_036_0	5	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	036	0	1	01	01	H5698_036_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5698	036	0	1	01	01	H5698_036_0	5	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	036	0	1	01	01	H5698_036_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	036	0	1	01	01	H5698_036_0	5	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00							1	4
H5698	036	0	1	01	01	H5698_036_0	5	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	036	0	1	01	01	H5698_036_0	5	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	037	0	1	01	01	H5698_037_0	4	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00								4
H5698	037	0	1	01	01	H5698_037_0	4	3	3	Tier 3	000010	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5698	037	0	1	01	01	H5698_037_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5698	037	0	1	01	01	H5698_037_0	4	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	1.00	3.00	1.00							1.00	3.00	1.00	1.00	3.00	1.00							1	4
H5698	037	0	1	01	01	H5698_037_0	4	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
H5698	037	0	1	01	01	H5698_037_0	4	3	1	Tier 3	000010	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
H5698	037	0	1	01	01	H5698_037_0	4	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
H5698	037	0	1	01	01	H5698_037_0	4	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	001	0	1	01	01	H5700_001_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	001	0	1	01	01	H5700_001_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5700	001	0	1	01	01	H5700_001_0	9	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	001	0	1	01	01	H5700_001_0	9	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	001	0	1	01	01	H5700_001_0	9	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	001	0	1	01	01	H5700_001_0	9	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	27.00	81.00								27.00				54.00								1	4
H5700	001	0	1	01	01	H5700_001_0	9	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	001	0	1	01	01	H5700_001_0	9	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5700	002	0	1	01	01	H5700_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	002	0	1	01	01	H5700_002_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	002	0	1	01	01	H5700_002_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	002	0	1	01	01	H5700_002_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	27.00	81.00								27.00				54.00								1	4
H5700	002	0	1	01	01	H5700_002_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	002	0	1	01	01	H5700_002_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5700	002	0	1	01	01	H5700_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5700	002	0	1	01	01	H5700_002_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	004	0	1	01	01	H5700_004_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5700	004	0	1	01	01	H5700_004_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5700	004	0	1	01	01	H5700_004_0	7	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	004	0	1	01	01	H5700_004_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	27.00	81.00								27.00				54.00								1	4
H5700	004	0	1	01	01	H5700_004_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	004	0	1	01	01	H5700_004_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	004	0	1	01	01	H5700_004_0	7	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	004	0	1	01	01	H5700_004_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	005	0	1	01	01	H5700_005_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	005	0	1	01	01	H5700_005_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5700	005	0	1	01	01	H5700_005_0	4	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5700	005	0	1	01	01	H5700_005_0	4	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	005	0	1	01	01	H5700_005_0	4	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	27.00	81.00								27.00				54.00								1	4
H5700	005	0	1	01	01	H5700_005_0	4	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	005	0	1	01	01	H5700_005_0	4	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	005	0	1	01	01	H5700_005_0	4	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	009	0	1	01	01	H5700_009_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5700	009	0	1	01	01	H5700_009_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5700	009	0	1	01	01	H5700_009_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	009	0	1	01	01	H5700_009_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	009	0	1	01	01	H5700_009_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	009	0	1	01	01	H5700_009_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	009	0	1	01	01	H5700_009_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	009	0	1	01	01	H5700_009_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5700	010	0	1	01	01	H5700_010_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	010	0	1	01	01	H5700_010_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5700	010	0	1	01	01	H5700_010_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5700	010	0	1	01	01	H5700_010_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	010	0	1	01	01	H5700_010_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	010	0	1	01	01	H5700_010_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5700	010	0	1	01	01	H5700_010_0	7	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	010	0	1	01	01	H5700_010_0	7	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	013	0	1	01	01	H5700_013_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5700	013	0	1	01	01	H5700_013_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5700	013	0	1	01	01	H5700_013_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	013	0	1	01	01	H5700_013_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	013	0	1	01	01	H5700_013_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	013	0	1	01	01	H5700_013_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	013	0	1	01	01	H5700_013_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	013	0	1	01	01	H5700_013_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	27.00	81.00								27.00				54.00								1	4
H5700	014	0	1	01	01	H5700_014_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5700	014	0	1	01	01	H5700_014_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5700	014	0	1	01	01	H5700_014_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	014	0	1	01	01	H5700_014_0	7	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	014	0	1	01	01	H5700_014_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	27.00	81.00								27.00				54.00								1	4
H5700	014	0	1	01	01	H5700_014_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	014	0	1	01	01	H5700_014_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	014	0	1	01	01	H5700_014_0	7	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	020	0	1	01	01	H5700_020_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5700	020	0	1	01	01	H5700_020_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5700	020	0	1	01	01	H5700_020_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	020	0	1	01	01	H5700_020_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	020	0	1	01	01	H5700_020_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5700	020	0	1	01	01	H5700_020_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	020	0	1	01	01	H5700_020_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	020	0	1	01	01	H5700_020_0	5	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5700	021	0	1	01	01	H5700_021_0	11	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5700	021	0	1	01	01	H5700_021_0	11	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				78.00									4
H5700	021	0	1	01	01	H5700_021_0	11	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	62.00	186.00								62.00				124.00									4
H5700	021	0	1	01	01	H5700_021_0	11	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5700	021	0	1	01	01	H5700_021_0	11	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5700	021	0	1	01	01	H5700_021_0	11	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5700	021	0	1	01	01	H5700_021_0	11	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5700	021	0	1	01	01	H5700_021_0	11	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5711	001	0	1	01	01	H5711_001_0	5	1	1	Generic	010000	3	2	Generic	011000000011001000000	34	90								34	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									4
H5711	001	0	1	01	01	H5711_001_0	5	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	100.00								50.00	100.00			100.00									4
H5711	001	0	1	01	01	H5711_001_0	5	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000011001000000	34	90								34	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	25.00	50.00								25.00	50.00			50.00									4
H5729	001	0	1	01	01	H5729_001_0	11	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	1	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	25.00	75.00								25.00			25.00	75.00									4
H5729	001	0	1	01	01	H5729_001_0	11	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	1	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	75.00									4
H5729	001	0	1	01	01	H5729_001_0	11	1	1	Generic	010000	3	2	Generic	011000000010011000000	30	90								30			30	90								Generic	1	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H5729	001	0	1	01	01	H5729_001_0	11	4	1	Tier Four Non-Preferred Brand	100000	3	2	Tier Four Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Tier Four Non-Preferred Brand	1	2		011000000010011000000	Tier Four Non-Preferred Brand																						Tier Four Non-Preferred Brand	25.00	75.00								25.00			25.00	75.00									4
H5729	004	0	1	01	01	H5729_004_0	10	1	1	Generic	010000	3	2	Generic	011000000010011000000	30	90								30			30	90								Generic	1	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5729	004	0	1	01	01	H5729_004_0	10	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	1	2		011000000010011000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00			15.00	45.00									4
H5729	004	0	1	01	01	H5729_004_0	10	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	1	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	75.00	225.00								75.00			75.00	225.00									4
H5729	004	0	1	01	01	H5729_004_0	10	4	1	Tier Four Non-Preferred Brand	100000	3	2	Tier Four Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Tier Four Non-Preferred Brand	1	2		011000000010011000000	Tier Four Non-Preferred Brand																						Tier Four Non-Preferred Brand	75.00	225.00								75.00			75.00	225.00									4
H5729	005	0	1	01	01	H5729_005_0	8	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	1	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	75.00	225.00								75.00			75.00	225.00									4
H5729	005	0	1	01	01	H5729_005_0	8	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	1	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	105.00									4
H5729	005	0	1	01	01	H5729_005_0	8	1	1	Generic	010000	3	2	Generic	011000000010011000000	30	90								30			30	90								Generic	1	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5729	005	0	1	01	01	H5729_005_0	8	4	1	Specialty	010010	3	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	1	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							4
H5729	006	0	1	01	01	H5729_006_0	7	1	1	Generic	010000	3	2	Generic	011000000010011000000	30	90								30			30	90								Generic	1	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5729	006	0	1	01	01	H5729_006_0	7	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	1	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5729	006	0	1	01	01	H5729_006_0	7	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	1	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	80.00	240.00								80.00			80.00	240.00									4
H5729	006	0	1	01	01	H5729_006_0	7	4	1	Specialty	010010	3	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	1	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							4
H5729	007	0	1	01	01	H5729_007_0	7	1	1	Generic	010000	3	2	Generic	011000000010011000000	30	90								30			30	90								Generic	1	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5729	007	0	1	01	01	H5729_007_0	7	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	1	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	90.00									4
H5729	007	0	1	01	01	H5729_007_0	7	4	1	Specialty	010010	3	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	1	1	011000000010011000000		Specialty	32	32								32			32	32								Specialty																							4
H5729	007	0	1	01	01	H5729_007_0	7	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	1	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	75.00	225.00								75.00			75.00	225.00									4
H5729	010	0	1	01	01	H5729_010_0	6	1	1	Generic	010000	3	2	Generic	011000000010011000000	30	90								30			30	90								Generic	1	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5729	010	0	1	01	01	H5729_010_0	6	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	1	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00			60.00	180.00									4
H5729	010	0	1	01	01	H5729_010_0	6	2	1	Preferred Brand	000001	3	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	1	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	90.00									4
H5729	010	0	1	01	01	H5729_010_0	6	4	1	Specialty	010010	3	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	1	1	011000000010011000000		Specialty	25	25								25			25	25								Specialty																							4
H5732	001	0	1	01	01	H5732_001_0	5	1	3	Generic	011100	1	2	Generic	000011000010001000000				30	90					30				90								Generic	2	2		000011000010001000000	Generic																						Generic				5.00	10.00					5.00				10.00								1	4
H5732	001	0	1	01	01	H5732_001_0	5	4	1	Specialty	100010	1	1	Specialty	000011000010001000000				30	90					30				90								Specialty	2	1	000011000010001000000		Specialty				20	20					20				20								Specialty																							4
H5732	001	0	1	01	01	H5732_001_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011000010001000000				30	90					30				90								Non-Preferred Brand	2	2		000011000010001000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	70.00					35.00				70.00									4
H5732	001	0	1	01	01	H5732_001_0	5	1	1	Generic	011100	1	2	Generic	000011000010001000000				30	90					30				90								Generic	2	2		000011000010001000000	Generic																						Generic				5.00	10.00					5.00				10.00									4
H5732	001	0	1	01	01	H5732_001_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011000010001000000				30	90					30				90								Preferred Brand	2	2		000011000010001000000	Preferred Brand																						Preferred Brand				20.00	40.00					20.00				40.00									4
H5732	001	0	1	01	01	H5732_001_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5732	001	0	1	01	01	H5732_001_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5732	001	0	1	01	01	H5732_001_0	5	4	3	Specialty	100010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5732	002	0	1	01	01	H5732_002_0	3	1	3	Generic	011100	1	2	Generic	000011000010001000000				30	90					30				90								Generic	2	2		000011000010001000000	Generic																						Generic				3.00	6.00					3.00				6.00								1	4
H5732	002	0	1	01	01	H5732_002_0	3	4	1	Specialty	100010	1	1	Specialty	000011000010001000000				30	90					30				90								Specialty	2	1	000011000010001000000		Specialty				20	20					20				20								Specialty																							4
H5732	002	0	1	01	01	H5732_002_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011000010001000000				30	90					30				90								Non-Preferred Brand	2	2		000011000010001000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	70.00					35.00				70.00									4
H5732	002	0	1	01	01	H5732_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011000010001000000				30	90					30				90								Preferred Brand	2	2		000011000010001000000	Preferred Brand																						Preferred Brand				20.00	40.00					20.00				40.00									4
H5732	002	0	1	01	01	H5732_002_0	3	1	1	Generic	011100	1	2	Generic	000011000010001000000				30	90					30				90								Generic	2	2		000011000010001000000	Generic																						Generic				3.00	6.00					3.00				6.00									4
H5732	002	0	1	01	01	H5732_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand	000011000010001000000				30	90					30				90								Preferred Brand	2	1	000011000010001000000		Preferred Brand				50	50					50				50								Preferred Brand																						1	4
H5732	002	0	1	01	01	H5732_002_0	3	4	3	Specialty	100010	1	1	Specialty	000011000010001000000				30	90					30				90								Specialty	2	1	000011000010001000000		Specialty				50	50					50				50								Specialty																						1	4
H5732	002	0	1	01	01	H5732_002_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011000010001000000				30	90					30				90								Non-Preferred Brand	2	1	000011000010001000000		Non-Preferred Brand				50	50					50				50								Non-Preferred Brand																						1	4
H5732	003	0	1	01	01	H5732_003_0	3	1	1	Generic	011100	1	2	Generic	000011000010011000000				30	90					30			30	90								Generic	2	2		000011000010011000000	Generic																						Generic				10.00	20.00					10.00			10.00	20.00									4
H5732	003	0	1	01	01	H5732_003_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011000010011000000				30	90					30			30	90								Preferred Brand	2	2		000011000010011000000	Preferred Brand																						Preferred Brand				25.00	50.00					25.00			25.00	50.00									4
H5732	003	0	1	01	01	H5732_003_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011000010011000000				30	90					30			30	90								Non-Preferred Brand	2	2		000011000010011000000	Non-Preferred Brand																						Non-Preferred Brand				40.00	80.00					40.00			40.00	80.00									4
H5732	003	0	1	01	01	H5732_003_0	3	4	1	Specialty	100010	1	1	Specialty	000011000010011000000				30	90					30			30	90								Specialty	2	2		000011000010011000000	Specialty																						Specialty				40.00	80.00					40.00			40.00	80.00									4
H5732	003	0	1	01	01	H5732_003_0	3	1	3	Generic	011100	1	2	Generic	000011000010011000000				30	90					30			30	90								Generic	2	2		000011000010011000000	Generic																						Generic				10.00	20.00					10.00			10.00	20.00								1	4
H5732	003	0	1	01	01	H5732_003_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand	000011000010011000000				30	90					30			30	90								Preferred Brand	2	2		000011000010011000000	Preferred Brand																						Preferred Brand				25.00	50.00					25.00			25.00	50.00								1	4
H5732	003	0	1	01	01	H5732_003_0	3	4	3	Specialty	100010	1	1	Specialty	000011000010011000000				30	90					30			30	90								Specialty	2	2		000011000010011000000	Specialty																						Specialty				40.00	80.00					40.00			40.00	80.00								1	4
H5732	003	0	1	01	01	H5732_003_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011000010011000000				30	90					30			30	90								Non-Preferred Brand	2	2		000011000010011000000	Non-Preferred Brand																						Non-Preferred Brand				40.00	80.00					40.00			40.00	80.00								1	4
H5736	003	0	1	09	04	H5736_003_0	3	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				37.00	92.50		37.00	111.00		74.00							74.00			111.00			3
H5736	003	0	1	09	04	H5736_003_0	3	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5736	003	0	1	09	04	H5736_003_0	3	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5736	004	0	1	09	04	H5736_004_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5736	004	0	1	09	04	H5736_004_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5736	004	0	1	09	04	H5736_004_0	2	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5736	004	0	1	09	04	H5736_004_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5736	004	0	1	09	04	H5736_004_0	2	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5736	004	0	1	09	04	H5736_004_0	2	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H5736	004	0	1	09	04	H5736_004_0	2	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H5736	004	0	1	09	04	H5736_004_0	2	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5736	005	0	1	09	04	H5736_005_0	2	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5736	005	0	1	09	04	H5736_005_0	2	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				37.00	92.50		37.00	111.00		74.00							74.00			111.00			3
H5736	005	0	1	09	04	H5736_005_0	2	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5736	006	0	1	09	04	H5736_006_0	2	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5736	006	0	1	09	04	H5736_006_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5736	006	0	1	09	04	H5736_006_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5736	006	0	1	09	04	H5736_006_0	2	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				25.00	62.50		25.00	75.00		50.00							50.00			75.00			4
H5736	006	0	1	09	04	H5736_006_0	2	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				55.00	137.50		55.00	165.00		110.00							110.00			165.00			4
H5736	006	0	1	09	04	H5736_006_0	2	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5736	006	0	1	09	04	H5736_006_0	2	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5736	006	0	1	09	04	H5736_006_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5736	007	0	1	09	04	H5736_007_0	5	3	1	Tier Three	010010	1	1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							4
H5736	007	0	1	09	04	H5736_007_0	5	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5736	007	0	1	09	04	H5736_007_0	5	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5736	007	0	1	09	04	H5736_007_0	5	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			4
H5736	007	0	1	09	04	H5736_007_0	5	2	1	Tier Two	000010	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			4
H5736	007	0	1	09	04	H5736_007_0	5	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00		1	4
H5736	008	0	1	09	04	H5736_008_0	5	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H5736	008	0	1	09	04	H5736_008_0	5	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5736	008	0	1	09	04	H5736_008_0	5	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H5736	008	0	1	09	04	H5736_008_0	5	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H5736	008	0	1	09	04	H5736_008_0	5	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H5736	008	0	1	09	04	H5736_008_0	5	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H5736	008	0	1	09	04	H5736_008_0	5	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5736	008	0	1	09	04	H5736_008_0	5	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5736	009	0	1	09	04	H5736_009_0	3	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5736	009	0	1	09	04	H5736_009_0	3	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	38.00	114.00								76.00							76.00			114.00			3
H5736	009	0	1	09	04	H5736_009_0	3	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5736	010	0	1	09	04	H5736_010_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H5736	010	0	1	09	04	H5736_010_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H5736	010	0	1	09	04	H5736_010_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H5736	010	0	1	09	04	H5736_010_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H5736	010	0	1	09	04	H5736_010_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H5736	010	0	1	09	04	H5736_010_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5736	010	0	1	09	04	H5736_010_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5736	010	0	1	09	04	H5736_010_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5750	001	0	1	02	01	H5750_001_0	5	3	1	Specialty	000010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	2		011000000010001000000	Specialty																						Specialty	50.00	150.00								50.00				150.00									4
H5750	001	0	1	02	01	H5750_001_0	5	2	1	Brand	000010	1	2	Brand	011000000010001000000	30	90								30				90								Brand	2	2		011000000010001000000	Brand																						Brand	25.00	75.00								25.00				75.00									4
H5750	001	0	1	02	01	H5750_001_0	5	1	1	Generic	010000	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	9.00	27.00								9.00				27.00									4
H5750	003	0	1	02	01	H5750_003_0	6	2	1	Brand	000010		2	Brand	011000000010001000000	30	90								30				90								Brand	2	2		011000000010001000000	Brand																						Brand	25.00	75.00								25.00				75.00									2
H5750	003	0	1	02	01	H5750_003_0	6	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	9.00	27.00								9.00				27.00									2
H5750	003	0	1	02	01	H5750_003_0	6	3	1	Specialty	000010		1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	2		011000000010001000000	Specialty																						Specialty	50.00	150.00								50.00				150.00									2
H5754	001	0	1	37	05	H5754_001_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5754	001	0	1	37	05	H5754_001_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5754	001	0	1	37	05	H5754_001_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5754	001	0	1	37	05	H5754_001_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5754	003	0	1	37	05	H5754_003_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5754	003	0	1	37	05	H5754_003_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5754	003	0	1	37	05	H5754_003_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5754	003	0	1	37	05	H5754_003_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5754	004	0	1	37	05	H5754_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5754	004	0	1	37	05	H5754_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5754	004	0	1	37	05	H5754_004_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5754	004	0	1	37	05	H5754_004_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5760	002	0	1	02	01	H5760_002_0	10	1	1	Tier 1	010001	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00									4
H5760	002	0	1	02	01	H5760_002_0	10	2	1	Tier 2	010001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00			90.00									4
H5760	002	0	1	02	01	H5760_002_0	10	3	1	Tier 3 and Tier 4	010010	1	2	Tier 3 and Tier 4	011000000011001000000	30	90								30	90			90								Tier 3 and Tier 4	2	2		011000000011001000000	Tier 3 and Tier 4																						Tier 3 and Tier 4	40.00	120.00								40.00	120.00			120.00									4
H5760	002	0	1	02	01	H5760_002_0	10	4	1	Tier 3 and Tier 4	010010	1	2	Tier 3 and Tier 4	011000000011001000000	30	90								30	90			90								Tier 3 and Tier 4	2	2		011000000011001000000	Tier 3 and Tier 4																						Tier 3 and Tier 4	40.00	120.00								40.00	120.00			120.00									4
H5760	003	0	1	02	01	H5760_003_0	10	3	3	Tier 3 and Tier 4	010010	1	2	Tier 3 and Tier 4																							Tier 3 and Tier 4					Tier 3 and Tier 4																						Tier 3 and Tier 4																						2	4
H5760	003	0	1	02	01	H5760_003_0	10	4	3	Tier 3 and Tier 4	010010	1	2	Tier 3 and Tier 4																							Tier 3 and Tier 4					Tier 3 and Tier 4																						Tier 3 and Tier 4																						2	4
H5760	003	0	1	02	01	H5760_003_0	10	2	3	Tier 2	010001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5760	003	0	1	02	01	H5760_003_0	10	1	3	Tier 1	010001	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
H5760	003	0	1	02	01	H5760_003_0	10	2	1	Tier 2	010001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00			90.00									4
H5760	003	0	1	02	01	H5760_003_0	10	3	1	Tier 3 and Tier 4	010010	1	2	Tier 3 and Tier 4	011000000011001000000	30	90								30	90			90								Tier 3 and Tier 4	2	2		011000000011001000000	Tier 3 and Tier 4																						Tier 3 and Tier 4	40.00	120.00								40.00	120.00			120.00									4
H5760	003	0	1	02	01	H5760_003_0	10	4	1	Tier 3 and Tier 4	010010	1	2	Tier 3 and Tier 4	011000000011001000000	30	90								30	90			90								Tier 3 and Tier 4	2	2		011000000011001000000	Tier 3 and Tier 4																						Tier 3 and Tier 4	40.00	120.00								40.00	120.00			120.00									4
H5760	003	0	1	02	01	H5760_003_0	10	1	1	Tier 1	010001	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H5760	004	0	1	02	01	H5760_004_0	8	4	1	Tier 2, 3 and 4	000010	3	2	Tier 2, 3 and 4	011000000011001000000	30	90								30	90			90								Tier 2, 3 and 4	2	2		011000000011001000000	Tier 2, 3 and 4																						Tier 2, 3 and 4	3.00	6.00								3.00	6.00			6.00									4
H5760	004	0	1	02	01	H5760_004_0	8	3	1	Tier 2, 3 and 4	000010	3	2	Tier 2, 3 and 4	011000000011001000000	30	90								30	90			90								Tier 2, 3 and 4	2	2		011000000011001000000	Tier 2, 3 and 4																						Tier 2, 3 and 4	3.00	6.00								3.00	6.00			6.00									4
H5760	004	0	1	02	01	H5760_004_0	8	2	1	Tier 2, 3 and 4	000010	3	2	Tier 2, 3 and 4	011000000011001000000	30	90								30	90			90								Tier 2, 3 and 4	2	2		011000000011001000000	Tier 2, 3 and 4																						Tier 2, 3 and 4	3.00	6.00								3.00	6.00			6.00									4
H5760	004	0	1	02	01	H5760_004_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	1.00	2.00								1.00	2.00			2.00									4
H5760	005	0	1	02	01	H5760_005_0	10	3	1	Tier 2, 3 and 4	000010	3	2	Tier 2, 3 and 4	011000000011001000000	30	90								30	90			90								Tier 2, 3 and 4	2	2		011000000011001000000	Tier 2, 3 and 4																						Tier 2, 3 and 4	3.00	6.00								3.00	6.00			6.00									4
H5760	005	0	1	02	01	H5760_005_0	10	4	1	Tier 2, 3 and 4	000010	3	2	Tier 2, 3 and 4	011000000011001000000	30	90								30	90			90								Tier 2, 3 and 4	2	2		011000000011001000000	Tier 2, 3 and 4																						Tier 2, 3 and 4	3.00	6.00								3.00	6.00			6.00									4
H5760	005	0	1	02	01	H5760_005_0	10	2	1	Tier 2, 3 and 4	000010	3	2	Tier 2, 3 and 4	011000000011001000000	30	90								30	90			90								Tier 2, 3 and 4	2	2		011000000011001000000	Tier 2, 3 and 4																						Tier 2, 3 and 4	3.00	6.00								3.00	6.00			6.00									4
H5760	005	0	1	02	01	H5760_005_0	10	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	1.00	2.00								1.00	2.00			2.00									4
H5774	005	0	1	01	01	H5774_005_0	8	1	3	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	5.00	5.00										5.00	5.00	5.00								1	4
H5774	005	0	1	01	01	H5774_005_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5774	005	0	1	01	01	H5774_005_0	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5774	005	0	1	01	01	H5774_005_0	8	4	3	Speciality	111111	1	1	Speciality																							Speciality					Speciality																						Speciality																						2	4
H5774	005	0	1	01	01	H5774_005_0	8	1	1	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	5.00	15.00										5.00	5.00	5.00									4
H5774	005	0	1	01	01	H5774_005_0	8	4	1	Speciality	111111	1	1	Speciality	011000000000111000000	31	90										10	31	90								Speciality	2	1	011000000000111000000		Speciality	25	25										25	25	25								Speciality																							4
H5774	005	0	1	01	01	H5774_005_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000111000000	31	90										10	31	90								Non-Preferred Brand	2	2		011000000000111000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00										30.00	30.00	30.00									4
H5774	005	0	1	01	01	H5774_005_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000111000000	31	90										10	31	90								Preferred Brand	2	2		011000000000111000000	Preferred Brand																						Preferred Brand	15.00	45.00										15.00	15.00	15.00									4
H5774	006	0	1	01	01	H5774_006_0	6	1	3	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	2.00	2.00										2.00	2.00	2.00								1	4
H5774	006	0	1	01	01	H5774_006_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000111000000	31	90										10	31	90								Non-Preferred Brand	2	2		011000000000111000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00										30.00	30.00	30.00									4
H5774	006	0	1	01	01	H5774_006_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5774	006	0	1	01	01	H5774_006_0	6	4	3	Speciality	111111	1	1	Speciality																							Speciality					Speciality																						Speciality																						2	4
H5774	006	0	1	01	01	H5774_006_0	6	4	1	Speciality	111111	1	1	Speciality	011000000000111000000	31	90										10	31	90								Speciality	2	1	011000000000111000000		Speciality	25	25										25	25	25								Speciality																							4
H5774	006	0	1	01	01	H5774_006_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5774	006	0	1	01	01	H5774_006_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000111000000	31	90										10	31	90								Preferred Brand	2	2		011000000000111000000	Preferred Brand																						Preferred Brand	12.00	24.00										12.00	12.00	12.00									4
H5774	006	0	1	01	01	H5774_006_0	6	1	1	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	2.00	4.00										2.00	2.00	2.00									4
H5774	007	0	1	01	01	H5774_007_0	6	4	1	Speciality	111111	1	1	Speciality	011000000000111000000	31	90										10	31	90								Speciality	2	1	011000000000111000000		Speciality	25	25										25	25	25								Speciality																							4
H5774	007	0	1	01	01	H5774_007_0	6	1	3	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	5.00	5.00										5.00	5.00	5.00								1	4
H5774	007	0	1	01	01	H5774_007_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5774	007	0	1	01	01	H5774_007_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5774	007	0	1	01	01	H5774_007_0	6	4	3	Speciality	111111	1	1	Speciality																							Speciality					Speciality																						Speciality																						2	4
H5774	007	0	1	01	01	H5774_007_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000111000000	31	90										10	31	90								Non-Preferred Brand	2	2		011000000000111000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00										30.00	30.00	30.00									4
H5774	007	0	1	01	01	H5774_007_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000111000000	31	90										10	31	90								Preferred Brand	2	2		011000000000111000000	Preferred Brand																						Preferred Brand	15.00	45.00										15.00	15.00	15.00									4
H5774	007	0	1	01	01	H5774_007_0	6	1	1	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	5.00	15.00										5.00	5.00	5.00									4
H5774	008	0	1	01	01	H5774_008_0	7	4	1	Speciality	111111	1	1	Speciality	011000000000111000000	31	90										10	31	90								Speciality	2	1	011000000000111000000		Speciality	25	25										25	25	25								Speciality																							4
H5774	008	0	1	01	01	H5774_008_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000111000000	31	90										10	31	90								Preferred Brand	2	2		011000000000111000000	Preferred Brand																						Preferred Brand	15.00	45.00										15.00	15.00	15.00									4
H5774	008	0	1	01	01	H5774_008_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000111000000	31	90										10	31	90								Non-Preferred Brand	2	2		011000000000111000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00										30.00	30.00	30.00									4
H5774	008	0	1	01	01	H5774_008_0	7	1	1	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	5.00	15.00										5.00	5.00	5.00									4
H5774	009	0	1	01	01	H5774_009_0	8	4	1	Speciality	111111	1	1	Speciality	011000000000111000000	31	90										10	31	90								Speciality	2	1	011000000000111000000		Speciality	25	25										25	25	25								Speciality																							4
H5774	009	0	1	01	01	H5774_009_0	8	1	1	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	5.00	15.00										5.00	5.00	5.00									4
H5774	009	0	1	01	01	H5774_009_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000111000000	31	90										10	31	90								Preferred Brand	2	2		011000000000111000000	Preferred Brand																						Preferred Brand	15.00	45.00										15.00	15.00	15.00									4
H5774	009	0	1	01	01	H5774_009_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000111000000	31	90										10	31	90								Non-Preferred Brand	2	2		011000000000111000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00										30.00	30.00	30.00									4
H5774	010	0	1	01	01	H5774_010_0	6	1	1	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	5.00	15.00										5.00	5.00	5.00									4
H5774	010	0	1	01	01	H5774_010_0	6	4	3	Speciality	111111	1	1	Speciality																							Speciality					Speciality																						Speciality																						2	4
H5774	010	0	1	01	01	H5774_010_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5774	010	0	1	01	01	H5774_010_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5774	010	0	1	01	01	H5774_010_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000111000000	31	90										10	31	90								Preferred Brand	2	2		011000000000111000000	Preferred Brand																						Preferred Brand	15.00	45.00										15.00	15.00	15.00									4
H5774	010	0	1	01	01	H5774_010_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000111000000	31	90										10	31	90								Non-Preferred Brand	2	2		011000000000111000000	Non-Preferred Brand																						Non-Preferred Brand	30.00	90.00										30.00	30.00	30.00									4
H5774	010	0	1	01	01	H5774_010_0	6	4	1	Speciality	111111	1	1	Speciality	011000000000111000000	31	90										10	31	90								Speciality	2	1	011000000000111000000		Speciality	25	25										25	25	25								Speciality																							4
H5774	010	0	1	01	01	H5774_010_0	6	1	3	Generic	010000	1	2	Generic	011000000000111000000	31	90										10	31	90								Generic	2	2		011000000000111000000	Generic																						Generic	5.00	5.00										5.00	5.00	5.00								1	4
H5783	002	0	1	01	01	H5783_002_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5783	002	0	1	01	01	H5783_002_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5783	002	0	1	01	01	H5783_002_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5783	002	0	1	01	01	H5783_002_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5783	002	0	1	01	01	H5783_002_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5783	002	0	1	01	01	H5783_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5783	002	0	1	01	01	H5783_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5783	002	0	1	01	01	H5783_002_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5783	003	0	1	01	01	H5783_003_0	7	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5783	003	0	1	01	01	H5783_003_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5783	003	0	1	01	01	H5783_003_0	7	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5783	003	0	1	01	01	H5783_003_0	7	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5783	003	0	1	01	01	H5783_003_0	7	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5783	003	0	1	01	01	H5783_003_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5783	003	0	1	01	01	H5783_003_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5783	003	0	1	01	01	H5783_003_0	7	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5783	006	0	1	01	01	H5783_006_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5783	006	0	1	01	01	H5783_006_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5783	006	0	1	01	01	H5783_006_0	6	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5783	006	0	1	01	01	H5783_006_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5783	006	0	1	01	01	H5783_006_0	6	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5783	006	0	1	01	01	H5783_006_0	6	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5783	006	0	1	01	01	H5783_006_0	6	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5783	006	0	1	01	01	H5783_006_0	6	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5783	007	0	1	01	01	H5783_007_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	9.00	27.00								9.00				18.00									4
H5783	007	0	1	01	01	H5783_007_0	8	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H5783	007	0	1	01	01	H5783_007_0	8	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5783	007	0	1	01	01	H5783_007_0	8	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	18.00	54.00								18.00				36.00								1	4
H5783	007	0	1	01	01	H5783_007_0	8	4	1	Tier 4	000010	1	1	Tier 4	011000000010001000000	30	90								30				90								Tier 4	2	1	011000000010001000000		Tier 4	25	25								25				25								Tier 4																							4
H5783	007	0	1	01	01	H5783_007_0	8	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	63.00	189.00								63.00				126.00									4
H5783	007	0	1	01	01	H5783_007_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				80.00									4
H5783	007	0	1	01	01	H5783_007_0	8	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
H5793	001	0	1	01	01	H5793_001_0	3	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5793	001	0	1	01	01	H5793_001_0	3	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			3
H5793	001	0	1	01	01	H5793_001_0	3	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5793	002	0	1	01	01	H5793_002_0	3	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5793	002	0	1	01	01	H5793_002_0	3	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5793	002	0	1	01	01	H5793_002_0	3	3	1	Tier Three	010010	1	1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							4
H5793	002	0	1	01	01	H5793_002_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00		1	4
H5793	002	0	1	01	01	H5793_002_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			4
H5793	002	0	1	01	01	H5793_002_0	3	2	1	Tier Two	000010	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	40.00	120.00								80.00							80.00			120.00			4
H5793	003	0	1	01	01	H5793_003_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H5793	003	0	1	01	01	H5793_003_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H5793	003	0	1	01	01	H5793_003_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H5793	003	0	1	01	01	H5793_003_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H5793	003	0	1	01	01	H5793_003_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H5793	003	0	1	01	01	H5793_003_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5793	003	0	1	01	01	H5793_003_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5793	003	0	1	01	01	H5793_003_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5794	001	0	1	01	01	H5794_001_0	4	3	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H5794	001	0	1	01	01	H5794_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
H5794	001	0	1	01	01	H5794_001_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				12.00									4
H5794	001	0	1	01	01	H5794_001_0	4	4	1	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Brand	2	2		011000000010001000000	Non-Preferred Generic/Brand																						Non-Preferred Generic/Brand	45.00	135.00								45.00				135.00									4
H5794	002	0	1	01	01	H5794_002_0	6	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				12.00								1	4
H5794	002	0	1	01	01	H5794_002_0	6	3	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5794	002	0	1	01	01	H5794_002_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5794	002	0	1	01	01	H5794_002_0	6	4	1	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Brand	2	2		011000000010001000000	Non-Preferred Generic/Brand																						Non-Preferred Generic/Brand	45.00	135.00								45.00				135.00									4
H5794	002	0	1	01	01	H5794_002_0	6	3	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H5794	002	0	1	01	01	H5794_002_0	6	4	3	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand																							Non-Preferred Generic/Brand					Non-Preferred Generic/Brand																						Non-Preferred Generic/Brand																						2	4
H5794	002	0	1	01	01	H5794_002_0	6	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				12.00									4
H5794	002	0	1	01	01	H5794_002_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
H5811	001	0	1	01	01	H5811_001_0	2	2	1	Brand	000010	1	2	Brand	011000000011011000000	34	90								34	90		34	90								Brand	2	2		011000000011011000000	Brand																						Brand	30.00	60.00								30.00	60.00		30.00	60.00									4
H5811	001	0	1	01	01	H5811_001_0	2	1	1	Generic	010000	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	10.00	20.00								10.00	20.00		10.00	20.00									4
H5811	001	0	1	01	01	H5811_001_0	2	3	1	Specialty	000010	1	1	Specialty	011000000011011000000	34	90								34	90		34	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							4
H5811	001	0	1	01	01	H5811_001_0	2	1	3	Generic	010000	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	10.00	20.00								10.00	20.00		10.00	20.00								1	4
H5811	001	0	1	01	01	H5811_001_0	2	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H5811	001	0	1	01	01	H5811_001_0	2	3	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5812	012	0	1	09	04	H5812_012_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H5812	012	0	1	09	04	H5812_012_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H5812	012	0	1	09	04	H5812_012_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H5812	013	0	1	09	04	H5812_013_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H5812	013	0	1	09	04	H5812_013_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H5812	013	0	1	09	04	H5812_013_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H5812	015	0	1	09	04	H5812_015_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H5812	015	0	1	09	04	H5812_015_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H5812	015	0	1	09	04	H5812_015_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H5812	016	0	1	09	04	H5812_016_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H5812	016	0	1	09	04	H5812_016_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H5812	016	0	1	09	04	H5812_016_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H5812	018	0	1	09	04	H5812_018_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H5812	018	0	1	09	04	H5812_018_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H5812	018	0	1	09	04	H5812_018_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H5812	019	0	1	09	04	H5812_019_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H5812	019	0	1	09	04	H5812_019_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H5812	019	0	1	09	04	H5812_019_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H5812	021	0	1	09	04	H5812_021_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H5812	021	0	1	09	04	H5812_021_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H5812	021	0	1	09	04	H5812_021_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H5812	022	0	1	09	04	H5812_022_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H5812	022	0	1	09	04	H5812_022_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H5812	022	0	1	09	04	H5812_022_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H5812	024	0	1	09	04	H5812_024_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H5812	024	0	1	09	04	H5812_024_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H5812	024	0	1	09	04	H5812_024_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H5812	025	0	1	09	04	H5812_025_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H5812	025	0	1	09	04	H5812_025_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H5812	025	0	1	09	04	H5812_025_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H5812	027	0	1	09	04	H5812_027_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H5812	027	0	1	09	04	H5812_027_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H5812	027	0	1	09	04	H5812_027_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H5812	028	0	1	09	04	H5812_028_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H5812	028	0	1	09	04	H5812_028_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H5812	028	0	1	09	04	H5812_028_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H5812	030	0	1	09	04	H5812_030_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H5812	030	0	1	09	04	H5812_030_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H5812	030	0	1	09	04	H5812_030_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H5812	031	0	1	09	04	H5812_031_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H5812	031	0	1	09	04	H5812_031_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H5812	031	0	1	09	04	H5812_031_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H5812	034	0	1	09	04	H5812_034_0	6	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	40.00	120.00								40.00				100.00									3
H5812	034	0	1	09	04	H5812_034_0	6	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	80.00	240.00								80.00				200.00									3
H5812	034	0	1	09	04	H5812_034_0	6	1	1	Tier 1 (generic drugs)	011000		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
H5812	035	0	1	09	04	H5812_035_0	5	1	1	Tier 1 (generic drugs)	011000	1	2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									4
H5812	035	0	1	09	04	H5812_035_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000	1	2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	50.00	150.00								50.00				125.00									4
H5812	035	0	1	09	04	H5812_035_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011	1	2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	25.00	75.00								25.00				62.50									4
H5813	002	0	1	01	01	H5813_002_0	5	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
H5813	002	0	1	01	01	H5813_002_0	5	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
H5813	002	0	1	01	01	H5813_002_0	5	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
H5813	003	0	1	01	01	H5813_003_0	6	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5813	003	0	1	01	01	H5813_003_0	6	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5813	003	0	1	01	01	H5813_003_0	6	3	1	Tier Three	010010	1	1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							4
H5813	003	0	1	01	01	H5813_003_0	6	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	30.00		10.00	30.00		20.00							20.00			30.00		1	4
H5813	003	0	1	01	01	H5813_003_0	6	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			4
H5813	003	0	1	01	01	H5813_003_0	6	2	1	Tier Two	000010	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5813	004	0	1	01	01	H5813_004_0	6	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
H5813	004	0	1	01	01	H5813_004_0	6	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
H5813	004	0	1	01	01	H5813_004_0	6	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
H5813	004	0	1	01	01	H5813_004_0	6	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
H5813	004	0	1	01	01	H5813_004_0	6	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
H5813	004	0	1	01	01	H5813_004_0	6	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5813	004	0	1	01	01	H5813_004_0	6	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5813	004	0	1	01	01	H5813_004_0	6	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5820	002	0	1	09	04	H5820_002_0	8	4	1	Tier 4	100100		1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							3
H5820	002	0	1	09	04	H5820_002_0	8	1	1	Tier 1	010000		2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					3
H5820	002	0	1	09	04	H5820_002_0	8	2	1	Tier 2	000101		2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	25.00	75.00		25.00	75.00		25.00	75.00		25.00				75.00	50.00		75.00	50.00					3
H5820	002	0	1	09	04	H5820_002_0	8	3	1	Tier 3	100000		2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	60.00	180.00		60.00	180.00		60.00	180.00		60.00				180.00	120.00		180.00	120.00					3
H5820	003	0	1	09	04	H5820_003_0	8	2	1	Tier 2	000101		2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	25.00	75.00		25.00	75.00		25.00	75.00		25.00				75.00	50.00		75.00	50.00					3
H5820	003	0	1	09	04	H5820_003_0	8	1	1	Tier 1	010000		2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					3
H5820	003	0	1	09	04	H5820_003_0	8	3	1	Tier 3	100000		2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	60.00	180.00		60.00	180.00		60.00	180.00		60.00				180.00	120.00		180.00	120.00					3
H5820	003	0	1	09	04	H5820_003_0	8	4	1	Tier 4	100100		1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							3
H5820	004	0	1	09	04	H5820_004_0	7	4	1	Tier 4	100100		1	Tier 4	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 4	2	1	011011011010001101100		Tier 4	33	33		33	33		33	33		33				33	33		33	33				Tier 4																							3
H5820	004	0	1	09	04	H5820_004_0	7	3	1	Tier 3	100000		2	Tier 3	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 3	2	2		011011011010001101100	Tier 3																						Tier 3	60.00	180.00		60.00	180.00		60.00	180.00		60.00				180.00	120.00		180.00	120.00					3
H5820	004	0	1	09	04	H5820_004_0	7	2	1	Tier 2	000101		2	Tier 2	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 2	2	2		011011011010001101100	Tier 2																						Tier 2	25.00	75.00		25.00	75.00		25.00	75.00		25.00				75.00	50.00		75.00	50.00					3
H5820	004	0	1	09	04	H5820_004_0	7	1	1	Tier 1	010000		2	Tier 1	011011011010001101100	30	90		30	90		30	90		30				90	60		90	60				Tier 1	2	2		011011011010001101100	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00	0.00		0.00	0.00					3
H5821	001	0	1	02	01	H5821_001_0	6	1	1	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	1	011100000010111000000		Generic	0	0	0							0		0	0	0								Generic																							4
H5821	001	0	1	02	01	H5821_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	1	011100000010111000000		Preferred Brand	25	25	25							25		25	25	25								Preferred Brand																							4
H5821	001	0	1	02	01	H5821_001_0	6	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	1	011100000010111000000		Non Preferred Brand	25	25	25							25		25	25	25								Non Preferred Brand																							4
H5821	001	0	1	02	01	H5821_001_0	6	4	1	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	1	011100000010111000000		Specialty	25	25	25							25		25	25	25								Specialty																							4
H5821	001	0	1	02	01	H5821_001_0	6	1	3	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	1	011100000010111000000		Generic	0	0	0							0		0	0	0								Generic																						1	4
H5821	001	0	1	02	01	H5821_001_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5821	001	0	1	02	01	H5821_001_0	6	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand																							Non Preferred Brand					Non Preferred Brand																						Non Preferred Brand																						2	4
H5821	001	0	1	02	01	H5821_001_0	6	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5821	004	0	1	02	01	H5821_004_0	7	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	2		011100000010111000000	Non Preferred Brand																						Non Preferred Brand	15.00	45.00	15.00							15.00		15.00	15.00	30.00									4
H5821	004	0	1	02	01	H5821_004_0	7	4	1	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	1	011100000010111000000		Specialty	20	20	20							20		20	20	20								Specialty																							4
H5821	004	0	1	02	01	H5821_004_0	7	1	3	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	1	011100000010111000000		Generic	0	0	0							0		0	0	0								Generic																						1	4
H5821	004	0	1	02	01	H5821_004_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5821	004	0	1	02	01	H5821_004_0	7	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand																							Non Preferred Brand					Non Preferred Brand																						Non Preferred Brand																						2	4
H5821	004	0	1	02	01	H5821_004_0	7	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5821	004	0	1	02	01	H5821_004_0	7	1	1	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	1	011100000010111000000		Generic	0	0	0							0		0	0	0								Generic																							4
H5821	004	0	1	02	01	H5821_004_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	2		011100000010111000000	Preferred Brand																						Preferred Brand	15.00	45.00	15.00							15.00		15.00	15.00	30.00									4
H5821	007	0	1	02	01	H5821_007_0	8	1	1	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	1	011100000010111000000		Generic	0	0	0							0		0	0	0								Generic																							4
H5821	007	0	1	02	01	H5821_007_0	8	4	3	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	1	011100000010111000000		Specialty	20	20	20							20		20	20	20								Specialty																						1	4
H5821	007	0	1	02	01	H5821_007_0	8	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	1	011100000010111000000		Non Preferred Brand	20	20	20							20		20	20	20								Non Preferred Brand																						1	4
H5821	007	0	1	02	01	H5821_007_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	1	011100000010111000000		Preferred Brand	20	20	20							20		20	20	20								Preferred Brand																						1	4
H5821	007	0	1	02	01	H5821_007_0	8	1	3	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	2		011100000010111000000	Generic																						Generic	0.00	0.00	0.00							0.00		0.00	0.00	0.00								1	4
H5821	007	0	1	02	01	H5821_007_0	8	4	1	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	1	011100000010111000000		Specialty	20	20	20							20		20	20	20								Specialty																							4
H5821	007	0	1	02	01	H5821_007_0	8	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	2		011100000010111000000	Non Preferred Brand																						Non Preferred Brand	15.00	45.00	15.00							15.00		15.00	15.00	30.00									4
H5821	007	0	1	02	01	H5821_007_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	2		011100000010111000000	Preferred Brand																						Preferred Brand	15.00	45.00	15.00							15.00		15.00	15.00	30.00									4
H5821	008	0	1	02	01	H5821_008_0	6	1	1	Generic	010000	1	2	Generic	011100000010011000000	30	90	15							30			30	90								Generic	1	1	011100000010111000000		Generic	0	0	0							0		0	0	0								Generic																							4
H5821	008	0	1	02	01	H5821_008_0	6	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	2		011100000010111000000	Non Preferred Brand																						Non Preferred Brand	5.00	15.00	5.00							5.00		5.00	5.00	10.00									4
H5821	008	0	1	02	01	H5821_008_0	6	4	1	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	2		011100000010111000000	Specialty																						Specialty	5.00	15.00	5.00							5.00		5.00	5.00	10.00									4
H5821	008	0	1	02	01	H5821_008_0	6	1	3	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	1	011100000010111000000		Generic	0	0	0							0		0	0	0								Generic																						1	4
H5821	008	0	1	02	01	H5821_008_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	2		011100000010111000000	Preferred Brand																						Preferred Brand	5.00	15.00	5.00							5.00		5.00	5.00	10.00								1	4
H5821	008	0	1	02	01	H5821_008_0	6	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	2		011100000010111000000	Non Preferred Brand																						Non Preferred Brand	5.00	15.00	5.00							5.00		5.00	5.00	10.00								1	4
H5821	008	0	1	02	01	H5821_008_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	2		011100000010111000000	Preferred Brand																						Preferred Brand	5.00	15.00	5.00							5.00		5.00	5.00	10.00									4
H5821	008	0	1	02	01	H5821_008_0	6	4	3	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	2		011100000010111000000	Specialty																						Specialty	5.00	15.00	5.00							5.00		5.00	5.00	10.00								1	4
H5821	009	0	1	02	01	H5821_009_0	4	1	1	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	2		011100000010111000000	Generic																						Generic	1.00	3.00	1.00							1.00		1.00	1.00	2.00									4
H5821	009	0	1	02	01	H5821_009_0	4	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	2		011100000010111000000	Non Preferred Brand																						Non Preferred Brand	3.00	9.00	3.00							3.00		3.00	3.00	6.00									4
H5821	009	0	1	02	01	H5821_009_0	4	4	1	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	2		011100000010111000000	Specialty																						Specialty	3.00	9.00	3.00							3.00		3.00	3.00	6.00									4
H5821	009	0	1	02	01	H5821_009_0	4	1	3	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	2		011100000010111000000	Generic																						Generic	1.00	3.00	1.00							1.00		1.00	1.00	2.00								1	4
H5821	009	0	1	02	01	H5821_009_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	2		011100000010111000000	Preferred Brand																						Preferred Brand	3.00	9.00	3.00							3.00		3.00	3.00	6.00								1	4
H5821	009	0	1	02	01	H5821_009_0	4	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	30							30		30	30	90								Non Preferred Brand	1	2		011100000010111000000	Non Preferred Brand																						Non Preferred Brand	3.00	9.00	3.00							3.00		3.00	3.00	6.00								1	4
H5821	009	0	1	02	01	H5821_009_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	2		011100000010111000000	Preferred Brand																						Preferred Brand	3.00	9.00	3.00							3.00		3.00	3.00	6.00									4
H5821	009	0	1	02	01	H5821_009_0	4	4	3	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	2		011100000010111000000	Specialty																						Specialty	3.00	9.00	3.00							3.00		3.00	3.00	6.00								1	4
H5821	013	0	1	02	01	H5821_013_0	7	1	1	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	1	011100000010111000000		Generic	0	0	0							0		0	0	0								Generic																							4
H5821	013	0	1	02	01	H5821_013_0	7	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	2		011100000010111000000	Non Preferred Brand																						Non Preferred Brand	15.00	45.00	15.00							15.00		15.00	15.00	30.00									4
H5821	013	0	1	02	01	H5821_013_0	7	4	1	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	1	011100000010111000000		Specialty	25	25	25							25		25	25	25								Specialty																							4
H5821	013	0	1	02	01	H5821_013_0	7	1	3	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	2		011100000010111000000	Generic																						Generic	0.00	0.00	0.00							0.00		0.00	0.00	0.00								1	4
H5821	013	0	1	02	01	H5821_013_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5821	013	0	1	02	01	H5821_013_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	2		011100000010111000000	Preferred Brand																						Preferred Brand	15.00	45.00	15.00							15.00		15.00	15.00	30.00									4
H5821	013	0	1	02	01	H5821_013_0	7	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5821	013	0	1	02	01	H5821_013_0	7	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand																							Non Preferred Brand					Non Preferred Brand																						Non Preferred Brand																						2	4
H5821	014	0	1	02	01	H5821_014_0	4	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	2		011100000010111000000	Non Preferred Brand																						Non Preferred Brand	3.00	9.00	3.00							3.00		3.00	3.00	6.00								1	4
H5821	014	0	1	02	01	H5821_014_0	4	4	3	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	2		011100000010111000000	Specialty																						Specialty	3.00	9.00	3.00							3.00		3.00	3.00	6.00								1	4
H5821	014	0	1	02	01	H5821_014_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	2		011100000010111000000	Preferred Brand																						Preferred Brand	3.00	9.00	3.00							3.00		3.00	3.00	6.00								1	4
H5821	014	0	1	02	01	H5821_014_0	4	1	3	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	2		011100000010111000000	Generic																						Generic	1.00	3.00	1.00							1.00		1.00	1.00	2.00								1	4
H5821	014	0	1	02	01	H5821_014_0	4	4	1	Specialty	010010	1	1	Specialty	011100000010111000000	30	90	15							30		15	30	90								Specialty	1	2		011100000010111000000	Specialty																						Specialty	3.00	9.00	3.00							3.00		3.00	3.00	6.00									4
H5821	014	0	1	02	01	H5821_014_0	4	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Non Preferred Brand	1	2		011100000010111000000	Non Preferred Brand																						Non Preferred Brand	3.00	9.00	3.00							3.00		3.00	3.00	6.00									4
H5821	014	0	1	02	01	H5821_014_0	4	1	1	Generic	010000	1	2	Generic	011100000010111000000	30	90	15							30		15	30	90								Generic	1	2		011100000010111000000	Generic																						Generic	1.00	3.00	1.00							1.00		1.00	1.00	2.00									4
H5821	014	0	1	02	01	H5821_014_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000010111000000	30	90	15							30		15	30	90								Preferred Brand	1	2		011100000010111000000	Preferred Brand																						Preferred Brand	3.00	9.00	3.00							3.00		3.00	3.00	6.00									4
H5826	008	0	1	01	01	H5826_008_0	3	1	1	Tier 1- Generic	010000		2	Tier 1- Generic	011000000010001000000	34	90								34				90								Tier 1- Generic	2	2		011000000010001000000	Tier 1- Generic																						Tier 1- Generic	7.00	21.00								7.00				21.00									3
H5826	008	0	1	01	01	H5826_008_0	3	2	1	Tier 2 - Brand	000010		2	Tier 2 - Brand	011000000010001000000	34	90								34				90								Tier 2 - Brand	2	2		011000000010001000000	Tier 2 - Brand																						Tier 2 - Brand	40.00	120.00								40.00				120.00									3
H5826	008	0	1	01	01	H5826_008_0	3	3	1	Tier 3 - Specialty	000010		1	Tier 3 - Specialty	011000000010001000000	34	90								34				90								Tier 3 - Specialty	2	1	011000000010001000000		Tier 3 - Specialty	33	33								33				33								Tier 3 - Specialty																							3
H5826	009	0	1	01	01	H5826_009_0	3	1	1	Tier 1- Generic	010000		2	Tier 1- Generic	011000000010001000000	34	90								34				90								Tier 1- Generic	2	2		011000000010001000000	Tier 1- Generic																						Tier 1- Generic	7.00	21.00								7.00				21.00									3
H5826	009	0	1	01	01	H5826_009_0	3	2	1	Tier 2 - Brand	000010		2	Tier 2 - Brand	011000000010001000000	34	90								34				90								Tier 2 - Brand	2	2		011000000010001000000	Tier 2 - Brand																						Tier 2 - Brand	40.00	120.00								40.00				120.00									3
H5826	009	0	1	01	01	H5826_009_0	3	3	1	Tier 3 - Specialty	000010		1	Tier 3 - Specialty	011000000010001000000	34	90								34				90								Tier 3 - Specialty	2	1	011000000010001000000		Tier 3 - Specialty	33	33								33				33								Tier 3 - Specialty																							3
H5832	001	0	1	01	01	H5832_001_0	3	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5832	001	0	1	01	01	H5832_001_0	3	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	39.00	117.00								78.00							78.00			117.00			3
H5832	001	0	1	01	01	H5832_001_0	3	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5832	002	0	1	01	01	H5832_002_0	3	2	1	Tier Two	000010	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	39.00	117.00								78.00							78.00			117.00			4
H5832	002	0	1	01	01	H5832_002_0	3	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5832	002	0	1	01	01	H5832_002_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00		1	4
H5832	002	0	1	01	01	H5832_002_0	3	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5832	002	0	1	01	01	H5832_002_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			4
H5832	002	0	1	01	01	H5832_002_0	3	3	1	Tier Three	010010	1	1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							4
H5832	003	0	1	01	01	H5832_003_0	3	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5832	003	0	1	01	01	H5832_003_0	3	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5832	003	0	1	01	01	H5832_003_0	3	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	39.00	117.00								78.00							78.00			117.00			3
H5832	004	0	1	01	01	H5832_004_0	4	3	3	Tier Three	010010	1	1	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5832	004	0	1	01	01	H5832_004_0	4	2	3	Tier Two	000010	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5832	004	0	1	01	01	H5832_004_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00		1	4
H5832	004	0	1	01	01	H5832_004_0	4	3	1	Tier Three	010010	1	1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							4
H5832	004	0	1	01	01	H5832_004_0	4	2	1	Tier Two	000010	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	39.00	117.00								78.00							78.00			117.00			4
H5832	004	0	1	01	01	H5832_004_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			4
H5839	001	0	1	09	04	H5839_001_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00										40.00		80.00									4
H5839	001	0	1	09	04	H5839_001_0	8	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
H5839	001	0	1	09	04	H5839_001_0	8	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									4
H5839	001	0	1	09	04	H5839_001_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	90.00										30.00		60.00									4
H5849	001	1	1	09	04	H5849_001_1	7	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				12.50									3
H5849	001	1	1	09	04	H5849_001_1	7	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				75.00									3
H5849	001	1	1	09	04	H5849_001_1	7	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00				150.00									3
H5849	001	1	1	09	04	H5849_001_1	7	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							3
H5849	001	2	1	09	04	H5849_001_2	7	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				12.50									3
H5849	001	2	1	09	04	H5849_001_2	7	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				75.00									3
H5849	001	2	1	09	04	H5849_001_2	7	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							3
H5849	001	2	1	09	04	H5849_001_2	7	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00				150.00									3
H5849	001	3	1	09	04	H5849_001_3	7	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				12.50									3
H5849	001	3	1	09	04	H5849_001_3	7	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								30				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00				150.00									3
H5849	001	3	1	09	04	H5849_001_3	7	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				75.00									3
H5849	001	3	1	09	04	H5849_001_3	7	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								30				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							3
H5850	001	0	1	01	01	H5850_001_0	5	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H5850	001	0	1	01	01	H5850_001_0	5	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H5850	001	0	1	01	01	H5850_001_0	5	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5850	001	0	1	01	01	H5850_001_0	5	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H5850	001	0	1	01	01	H5850_001_0	5	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H5850	001	0	1	01	01	H5850_001_0	5	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H5850	001	0	1	01	01	H5850_001_0	5	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H5850	001	0	1	01	01	H5850_001_0	5	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				30.00			30.00			30.00													4
H5850	003	0	1	01	01	H5850_003_0	4	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H5850	003	0	1	01	01	H5850_003_0	4	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H5850	003	0	1	01	01	H5850_003_0	4	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5850	003	0	1	01	01	H5850_003_0	4	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H5850	003	0	1	01	01	H5850_003_0	4	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H5850	003	0	1	01	01	H5850_003_0	4	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				30.00			30.00			30.00													4
H5850	003	0	1	01	01	H5850_003_0	4	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				15.00	45.00	30.00	15.00			15.00			15.00	45.00	30.00								4
H5850	003	0	1	01	01	H5850_003_0	4	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H5850	004	0	1	01	01	H5850_004_0	5	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				20.00	60.00	40.00	20.00			20.00			20.00	60.00	40.00								4
H5850	004	0	1	01	01	H5850_004_0	5	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H5850	004	0	1	01	01	H5850_004_0	5	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				50.00			50.00			50.00													4
H5850	004	0	1	01	01	H5850_004_0	5	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H5850	004	0	1	01	01	H5850_004_0	5	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H5850	004	0	1	01	01	H5850_004_0	5	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H5850	004	0	1	01	01	H5850_004_0	5	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H5850	004	0	1	01	01	H5850_004_0	5	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5850	005	0	1	01	01	H5850_005_0	5	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H5850	005	0	1	01	01	H5850_005_0	5	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				23.00	69.00	46.00	23.00			23.00			23.00	69.00	46.00								4
H5850	005	0	1	01	01	H5850_005_0	5	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				50.00			50.00			50.00													4
H5850	005	0	1	01	01	H5850_005_0	5	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H5850	006	0	1	01	01	H5850_006_0	6	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H5850	006	0	1	01	01	H5850_006_0	6	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				50.00			50.00			50.00													4
H5850	006	0	1	01	01	H5850_006_0	6	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				30.00	90.00	60.00	30.00			30.00			30.00	90.00	60.00								4
H5850	006	0	1	01	01	H5850_006_0	6	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H5850	007	0	1	01	01	H5850_007_0	5	2	3	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs																							Preferred Brand Drugs					Preferred Brand Drugs																						Preferred Brand Drugs																						2	4
H5850	007	0	1	01	01	H5850_007_0	5	3	3	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs																							Non-Preferred Generic & Non-Preferred Brand Drugs					Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs																						2	4
H5850	007	0	1	01	01	H5850_007_0	5	4	3	Specialty Drugs	010010	3	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5850	007	0	1	01	01	H5850_007_0	5	1	3	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00							1	4
H5850	007	0	1	01	01	H5850_007_0	5	1	1	Preferred Generic and Preferred Brand Drugs	001001	3	2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								4
H5850	007	0	1	01	01	H5850_007_0	5	2	1	Preferred Brand Drugs	000001	3	2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				20.00	60.00	40.00	20.00			20.00			20.00	80.00	40.00								4
H5850	007	0	1	01	01	H5850_007_0	5	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100	3	2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				40.00			40.00			40.00													4
H5850	007	0	1	01	01	H5850_007_0	5	4	1	Specialty Drugs	010010	3	1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													4
H5850	009	0	1	01	01	H5850_009_0	4	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100		2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				100.00			100.00			100.00													3
H5850	009	0	1	01	01	H5850_009_0	4	2	1	Preferred Brand Drugs	000001		2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				40.00	120.00	80.00	40.00			40.00			40.00	120.00	80.00								3
H5850	009	0	1	01	01	H5850_009_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													3
H5850	009	0	1	01	01	H5850_009_0	4	1	1	Preferred Generic and Preferred Brand Drugs	001001		2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								3
H5850	010	0	1	01	01	H5850_010_0	4	3	1	Non-Preferred Generic & Non-Preferred Brand Drugs	100100		2	Non-Preferred Generic & Non-Preferred Brand Drugs	000010010010000000000				30			30			30												Non-Preferred Generic & Non-Preferred Brand Drugs	1	2		000010010010000000000	Non-Preferred Generic & Non-Preferred Brand Drugs																						Non-Preferred Generic & Non-Preferred Brand Drugs				100.00			100.00			100.00													3
H5850	010	0	1	01	01	H5850_010_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	000010010010000000000				30			30			30												Specialty Drugs	1	2		000010010010000000000	Specialty Drugs																						Specialty Drugs				100.00			100.00			100.00													3
H5850	010	0	1	01	01	H5850_010_0	4	2	1	Preferred Brand Drugs	000001		2	Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Brand Drugs	1	2		000011110010011100000	Preferred Brand Drugs																						Preferred Brand Drugs				40.00	120.00	80.00	40.00			40.00			40.00	120.00	80.00								3
H5850	010	0	1	01	01	H5850_010_0	4	1	1	Preferred Generic and Preferred Brand Drugs	001001		2	Preferred Generic and Preferred Brand Drugs	000011110010011100000				30	90	60	30			30			30	90	60							Preferred Generic and Preferred Brand Drugs	1	2		000011110010011100000	Preferred Generic and Preferred Brand Drugs																						Preferred Generic and Preferred Brand Drugs				0.00	0.00	0.00	0.00			0.00			0.00	0.00	0.00								3
H5854	002	0	1	01	01	H5854_002_0	4	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H5854	002	0	1	01	01	H5854_002_0	4	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	24.00								8.00				20.00								1	4
H5854	002	0	1	01	01	H5854_002_0	4	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5854	002	0	1	01	01	H5854_002_0	4	3	3	Formulary Brand	100010	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5854	002	0	1	01	01	H5854_002_0	4	4	3	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand																							Specialty Formulary Brand					Specialty Formulary Brand																						Specialty Formulary Brand																						2	4
H5854	002	0	1	01	01	H5854_002_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	24.00								8.00				20.00									4
H5854	002	0	1	01	01	H5854_002_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	29.00	87.00								29.00				72.50									4
H5854	002	0	1	01	01	H5854_002_0	4	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	60.00	180.00								60.00				150.00									4
H5854	003	0	1	01	01	H5854_003_0	4	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	24.00								8.00				20.00								1	4
H5854	003	0	1	01	01	H5854_003_0	4	4	1	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand	011000000010001000000	30	90								30				90								Specialty Formulary Brand	2	1	011000000010001000000		Specialty Formulary Brand	25	25								25				25								Specialty Formulary Brand																							4
H5854	003	0	1	01	01	H5854_003_0	4	3	1	Formulary Brand	100010	1	2	Formulary Brand	011000000010001000000	30	90								30				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	60.00	180.00								60.00				150.00									4
H5854	003	0	1	01	01	H5854_003_0	4	3	3	Formulary Brand	100010	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H5854	003	0	1	01	01	H5854_003_0	4	4	3	Specialty Formulary Brand	000010	1	1	Specialty Formulary Brand																							Specialty Formulary Brand					Specialty Formulary Brand																						Specialty Formulary Brand																						2	4
H5854	003	0	1	01	01	H5854_003_0	4	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H5854	003	0	1	01	01	H5854_003_0	4	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	29.00	87.00								29.00				72.50									4
H5854	003	0	1	01	01	H5854_003_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	24.00								8.00				20.00									4
H5862	001	0	1	09	04	H5862_001_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand	2	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00	180.00		60.00	180.00									4
H5862	001	0	1	09	04	H5862_001_0	4	4	1	Injectable Drugs	110001	1	1	Injectable Drugs	011000000011011000000	30	90								30	90		30	90								Injectable Drugs	2	1	011000000011011000000		Injectable Drugs	25	25								25	25		25	25								Injectable Drugs																							4
H5862	001	0	1	09	04	H5862_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	30	90								30	90		30	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00		30.00	90.00									4
H5862	001	0	1	09	04	H5862_001_0	4	1	1	Generic	010000	1	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	15.00									4
H5862	001	0	1	09	04	H5862_001_0	4	5	1	Speccialty Drugs	110001	1	1	Speccialty Drugs	011000000011011000000	30	90								30	90		30	90								Speccialty Drugs	2	1	011000000011011000000		Speccialty Drugs	25	25								25	25		25	25								Speccialty Drugs																							4
H5883	002	1	1	01	01	H5883_002_1	10	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	002	1	1	01	01	H5883_002_1	10	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	002	1	1	01	01	H5883_002_1	10	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	002	1	1	01	01	H5883_002_1	10	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	002	1	1	01	01	H5883_002_1	10	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	002	2	1	01	01	H5883_002_2	9	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	002	2	1	01	01	H5883_002_2	9	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	002	2	1	01	01	H5883_002_2	9	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	002	2	1	01	01	H5883_002_2	9	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	002	2	1	01	01	H5883_002_2	9	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	002	3	1	01	01	H5883_002_3	9	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	002	3	1	01	01	H5883_002_3	9	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	002	3	1	01	01	H5883_002_3	9	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	002	3	1	01	01	H5883_002_3	9	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	002	3	1	01	01	H5883_002_3	9	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	002	4	1	01	01	H5883_002_4	9	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	002	4	1	01	01	H5883_002_4	9	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	002	4	1	01	01	H5883_002_4	9	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	002	4	1	01	01	H5883_002_4	9	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	002	4	1	01	01	H5883_002_4	9	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	002	7	1	01	01	H5883_002_7	9	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	002	7	1	01	01	H5883_002_7	9	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	002	7	1	01	01	H5883_002_7	9	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	002	7	1	01	01	H5883_002_7	9	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	002	7	1	01	01	H5883_002_7	9	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	003	1	1	01	01	H5883_003_1	8	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	003	1	1	01	01	H5883_003_1	8	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	003	1	1	01	01	H5883_003_1	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	003	1	1	01	01	H5883_003_1	8	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	003	1	1	01	01	H5883_003_1	8	5	3	Injectable	010010	1	2	Injectable																							Injectable					Injectable																						Injectable																						2	4
H5883	003	1	1	01	01	H5883_003_1	8	1	3	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				5.00	15.00		5.00	15.00		5.00			5.00	15.00								1	4
H5883	003	1	1	01	01	H5883_003_1	8	2	3	Formulary Options	000001	1	2	Formulary Options																							Formulary Options					Formulary Options																						Formulary Options																						2	4
H5883	003	1	1	01	01	H5883_003_1	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5883	003	1	1	01	01	H5883_003_1	8	4	3	High Cost/Specialty	000010	1	1	High Cost/Specialty																							High Cost/Specialty					High Cost/Specialty																						High Cost/Specialty																						2	4
H5883	003	1	1	01	01	H5883_003_1	8	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	003	2	1	01	01	H5883_003_2	8	4	3	High Cost/Specialty	000010	1	1	High Cost/Specialty																							High Cost/Specialty					High Cost/Specialty																						High Cost/Specialty																						2	4
H5883	003	2	1	01	01	H5883_003_2	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5883	003	2	1	01	01	H5883_003_2	8	2	3	Formulary Options	000001	1	2	Formulary Options																							Formulary Options					Formulary Options																						Formulary Options																						2	4
H5883	003	2	1	01	01	H5883_003_2	8	1	3	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				5.00	15.00		5.00	15.00		5.00			5.00	15.00								1	4
H5883	003	2	1	01	01	H5883_003_2	8	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	003	2	1	01	01	H5883_003_2	8	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	003	2	1	01	01	H5883_003_2	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	003	2	1	01	01	H5883_003_2	8	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	003	2	1	01	01	H5883_003_2	8	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	003	2	1	01	01	H5883_003_2	8	5	3	Injectable	010010	1	2	Injectable																							Injectable					Injectable																						Injectable																						2	4
H5883	003	3	1	01	01	H5883_003_3	9	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	003	3	1	01	01	H5883_003_3	9	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	003	3	1	01	01	H5883_003_3	9	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	003	3	1	01	01	H5883_003_3	9	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	003	3	1	01	01	H5883_003_3	9	5	3	Injectable	010010	1	2	Injectable																							Injectable					Injectable																						Injectable																						2	4
H5883	003	3	1	01	01	H5883_003_3	9	1	3	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				5.00	15.00		5.00	15.00		5.00			5.00	15.00								1	4
H5883	003	3	1	01	01	H5883_003_3	9	2	3	Formulary Options	000001	1	2	Formulary Options																							Formulary Options					Formulary Options																						Formulary Options																						2	4
H5883	003	3	1	01	01	H5883_003_3	9	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5883	003	3	1	01	01	H5883_003_3	9	4	3	High Cost/Specialty	000010	1	1	High Cost/Specialty																							High Cost/Specialty					High Cost/Specialty																						High Cost/Specialty																						2	4
H5883	003	3	1	01	01	H5883_003_3	9	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	003	4	1	01	01	H5883_003_4	8	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	003	4	1	01	01	H5883_003_4	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	003	4	1	01	01	H5883_003_4	8	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	003	4	1	01	01	H5883_003_4	8	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	003	4	1	01	01	H5883_003_4	8	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	003	4	1	01	01	H5883_003_4	8	5	3	Injectable	010010	1	2	Injectable																							Injectable					Injectable																						Injectable																						2	4
H5883	003	4	1	01	01	H5883_003_4	8	4	3	High Cost/Specialty	000010	1	1	High Cost/Specialty																							High Cost/Specialty					High Cost/Specialty																						High Cost/Specialty																						2	4
H5883	003	4	1	01	01	H5883_003_4	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5883	003	4	1	01	01	H5883_003_4	8	2	3	Formulary Options	000001	1	2	Formulary Options																							Formulary Options					Formulary Options																						Formulary Options																						2	4
H5883	003	4	1	01	01	H5883_003_4	8	1	3	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				5.00	15.00		5.00	15.00		5.00			5.00	15.00								1	4
H5883	003	5	1	01	01	H5883_003_5	8	1	1	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				3.00	7.50		3.00	9.00		3.00			3.00	7.50									4
H5883	003	5	1	01	01	H5883_003_5	8	2	1	Formulary Options	000001	1	2	Formulary Options	000011011010011000000				34	90		34	90		34			34	90								Formulary Options	2	2		000011011010011000000	Formulary Options																						Formulary Options				25.00	62.50		25.00	75.00		25.00			25.00	62.50									4
H5883	003	5	1	01	01	H5883_003_5	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010011000000				34	90		34	90		34			34	90								Non-Preferred Brand	2	2		000011011010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	125.00		50.00	150.00		50.00			50.00	125.00									4
H5883	003	5	1	01	01	H5883_003_5	8	4	1	High Cost/Specialty	000010	1	1	High Cost/Specialty	000010010010010000000				34			34			34			34									High Cost/Specialty	2	1	000010010010010000000		High Cost/Specialty				25			25			25			25									High Cost/Specialty																							4
H5883	003	5	1	01	01	H5883_003_5	8	5	3	Injectable	010010	1	2	Injectable																							Injectable					Injectable																						Injectable																						2	4
H5883	003	5	1	01	01	H5883_003_5	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5883	003	5	1	01	01	H5883_003_5	8	2	3	Formulary Options	000001	1	2	Formulary Options																							Formulary Options					Formulary Options																						Formulary Options																						2	4
H5883	003	5	1	01	01	H5883_003_5	8	1	3	Formulary Preferred	001000	1	2	Formulary Preferred	000011011010011000000				34	90		34	90		34			34	90								Formulary Preferred	2	2		000011011010011000000	Formulary Preferred																						Formulary Preferred				5.00	15.00		5.00	15.00		5.00			5.00	15.00								1	4
H5883	003	5	1	01	01	H5883_003_5	8	5	1	Injectable	010010	1	2	Injectable	000010010010010000000				34			34			34			34									Injectable	2	1	000010010010010000000		Injectable				25			25			25			25									Injectable																							4
H5883	003	5	1	01	01	H5883_003_5	8	4	3	High Cost/Specialty	000010	1	1	High Cost/Specialty																							High Cost/Specialty					High Cost/Specialty																						High Cost/Specialty																						2	4
H5884	002	1	1	09	04	H5884_002_1	3	3	1	Tier 3	100000		2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	137.50									3
H5884	002	1	1	09	04	H5884_002_1	3	2	1	Tier 2	000001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	75.00									3
H5884	002	1	1	09	04	H5884_002_1	3	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	12.50									3
H5884	002	1	1	09	04	H5884_002_1	3	4	1	Tier 4	000010		1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	1	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							3
H5884	002	2	1	09	04	H5884_002_2	3	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	12.50									3
H5884	002	2	1	09	04	H5884_002_2	3	2	1	Tier 2	000001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	75.00									3
H5884	002	2	1	09	04	H5884_002_2	3	3	1	Tier 3	100000		2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	137.50									3
H5884	002	2	1	09	04	H5884_002_2	3	4	1	Tier 4	000010		1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	1	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							3
H5884	003	1	1	09	04	H5884_003_1	3	3	1	Tier 3	100000		2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	137.50									3
H5884	003	1	1	09	04	H5884_003_1	3	2	1	Tier 2	000001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	75.00									3
H5884	003	1	1	09	04	H5884_003_1	3	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	12.50									3
H5884	003	1	1	09	04	H5884_003_1	3	4	1	Tier 4	000010		1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	1	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							3
H5884	003	2	1	09	04	H5884_003_2	3	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	12.50									3
H5884	003	2	1	09	04	H5884_003_2	3	2	1	Tier 2	000001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	75.00									3
H5884	003	2	1	09	04	H5884_003_2	3	3	1	Tier 3	100000		2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	137.50									3
H5884	003	2	1	09	04	H5884_003_2	3	4	1	Tier 4	000010		1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	1	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							3
H5884	004	1	1	09	04	H5884_004_1	4	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	12.50									3
H5884	004	1	1	09	04	H5884_004_1	4	2	1	Tier 2	000001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	75.00									3
H5884	004	1	1	09	04	H5884_004_1	4	4	1	Tier 4	000010		1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	1	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							3
H5884	004	1	1	09	04	H5884_004_1	4	3	1	Tier 3	100000		2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	137.50									3
H5884	004	2	1	09	04	H5884_004_2	4	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	12.50									3
H5884	004	2	1	09	04	H5884_004_2	4	3	1	Tier 3	100000		2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	137.50									3
H5884	004	2	1	09	04	H5884_004_2	4	2	1	Tier 2	000001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	75.00									3
H5884	004	2	1	09	04	H5884_004_2	4	4	1	Tier 4	000010		1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	1	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							3
H5893	002	0	1	01	01	H5893_002_0	2	1	3	Tier 1	001000	1	2	Tier 1	011000000000100000000	30	90										7										Tier 1	2	1	011000000000100000000		Tier 1	25	25										25										Tier 1																						1	4
H5893	002	0	1	01	01	H5893_002_0	2	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H5895	001	0	1	01	01	H5895_001_0	3	3	1	Non Preferred Brand	100000		2	Non Preferred Brand	011100000010011100000	30	90	60							30			30	90	60							Non Preferred Brand	2	1	011100000010011100000		Non Preferred Brand	25	25	25							25			25	25	25							Non Preferred Brand																							2
H5895	001	0	1	01	01	H5895_001_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010011100000	30	90	60							30			30	90	60							Preferred Brand	2	2		011100000010011100000	Preferred Brand																						Preferred Brand	35.00	35.00	35.00							35.00			35.00	35.00	35.00								2
H5895	001	0	1	01	01	H5895_001_0	3	1	1	Generic	010000		2	Generic	011100000010011100000	30	90	60							30			30	90	60							Generic	2	2		011100000010011100000	Generic																						Generic	5.00	5.00	5.00							5.00			5.00	5.00	5.00								2
H5895	001	0	1	01	01	H5895_001_0	3	4	1	Specialty	110001		1	Specialty	011100000010011100000	30	90	60							30			30	90	60							Specialty	2	1	011100000010011100000		Specialty	25	25	25							25			25	25	25							Specialty																							2
H5896	001	0	1	01	01	H5896_001_0	6	1	1	Generic	010000	1	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	0.00	0.00								0.00	0.00		0.00	0.00									4
H5896	001	0	1	01	01	H5896_001_0	6	2	1	Brand	000010	1	2	Brand	011000000011011000000	30	90								30	90		30	90								Brand	2	2		011000000011011000000	Brand																						Brand	40.00	120.00								40.00	120.00		40.00	120.00									4
H5918	001	0	1	37	05	H5918_001_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5918	001	0	1	37	05	H5918_001_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5918	001	0	1	37	05	H5918_001_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5918	001	0	1	37	05	H5918_001_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5918	003	0	1	37	05	H5918_003_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5918	003	0	1	37	05	H5918_003_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5918	003	0	1	37	05	H5918_003_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5918	003	0	1	37	05	H5918_003_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5918	004	0	1	37	05	H5918_004_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	3.00	9.00								3.00							6.00			9.00			4
H5918	004	0	1	37	05	H5918_004_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							170.00			180.00			4
H5918	004	0	1	37	05	H5918_004_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	29.00	87.00								29.00							77.00			87.00			4
H5918	004	0	1	37	05	H5918_004_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H5928	002	0	1	01	01	H5928_002_0	7	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	1	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	16.00								8.00				16.00									4
H5928	002	0	1	01	01	H5928_002_0	7	4	1	Formulary High Cost	000011	1	1	Formulary High Cost	011000000010001000000	30	90								30				90								Formulary High Cost	1	1	011000000010001000000		Formulary High Cost	20	20								20				20								Formulary High Cost																							4
H5928	002	0	1	01	01	H5928_002_0	7	3	1	Formulary non Preferred Brand	100000	1	2	Formulary non Preferred Brand	011000000010001000000	30	90								30				90								Formulary non Preferred Brand	1	2		011000000010001000000	Formulary non Preferred Brand																						Formulary non Preferred Brand	40.00	80.00								40.00				80.00									4
H5928	002	0	1	01	01	H5928_002_0	7	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	1	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	15.00	30.00								15.00				30.00									4
H5936	001	0	1	01	01	H5936_001_0	6	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5936	001	0	1	01	01	H5936_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H5936	001	0	1	01	01	H5936_001_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00			60.00	180.00									4
H5936	001	0	1	01	01	H5936_001_0	6	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5936	001	0	1	01	01	H5936_001_0	6	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5936	001	0	1	01	01	H5936_001_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5936	001	0	1	01	01	H5936_001_0	6	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5936	001	0	1	01	01	H5936_001_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5936	005	0	1	01	01	H5936_005_0	5	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5936	005	0	1	01	01	H5936_005_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H5936	005	0	1	01	01	H5936_005_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5936	005	0	1	01	01	H5936_005_0	5	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
H5936	005	0	1	01	01	H5936_005_0	5	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5936	005	0	1	01	01	H5936_005_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5936	005	0	1	01	01	H5936_005_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5936	005	0	1	01	01	H5936_005_0	5	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5936	006	0	1	01	01	H5936_006_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5936	006	0	1	01	01	H5936_006_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5936	006	0	1	01	01	H5936_006_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5936	006	0	1	01	01	H5936_006_0	4	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5936	006	0	1	01	01	H5936_006_0	4	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
H5936	006	0	1	01	01	H5936_006_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5936	006	0	1	01	01	H5936_006_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00			20.00	60.00									4
H5936	006	0	1	01	01	H5936_006_0	4	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5936	008	0	1	01	01	H5936_008_0	6	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5936	008	0	1	01	01	H5936_008_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5936	008	0	1	01	01	H5936_008_0	6	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5936	008	0	1	01	01	H5936_008_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5936	008	0	1	01	01	H5936_008_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	210.00								70.00			70.00	210.00									4
H5936	008	0	1	01	01	H5936_008_0	6	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5936	008	0	1	01	01	H5936_008_0	6	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5936	008	0	1	01	01	H5936_008_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5936	009	0	1	01	01	H5936_009_0	5	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5936	009	0	1	01	01	H5936_009_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5936	009	0	1	01	01	H5936_009_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	210.00								70.00			70.00	210.00									4
H5936	009	0	1	01	01	H5936_009_0	5	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5936	009	0	1	01	01	H5936_009_0	5	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5936	009	0	1	01	01	H5936_009_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5936	009	0	1	01	01	H5936_009_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5936	009	0	1	01	01	H5936_009_0	5	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5936	013	0	1	01	01	H5936_013_0	7	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5936	013	0	1	01	01	H5936_013_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5936	013	0	1	01	01	H5936_013_0	7	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00								1	4
H5936	013	0	1	01	01	H5936_013_0	7	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H5936	013	0	1	01	01	H5936_013_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00			40.00	120.00									4
H5936	013	0	1	01	01	H5936_013_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	15.00	45.00								15.00			15.00	45.00									4
H5936	013	0	1	01	01	H5936_013_0	7	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	0.00	0.00								0.00			0.00	0.00									4
H5936	013	0	1	01	01	H5936_013_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5938	001	0	1	01	01	H5938_001_0	5	3	1	Non Preferred Brand	100000		2	Non Preferred Brand	010000000010000000000	30									30												Non Preferred Brand	1	2		010000000010000000000	Non Preferred Brand																						Non Preferred Brand	50.00									50.00													3
H5938	001	0	1	01	01	H5938_001_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	010000000010000000000	30									30												Preferred Brand	2	2		010000000010000000000	Preferred Brand																						Preferred Brand	30.00									30.00													3
H5938	001	0	1	01	01	H5938_001_0	5	1	1	Preferred Generic	001000		2	Preferred Generic	010000000010000000000	30									30												Preferred Generic	2	2		010000000010000000000	Preferred Generic																						Preferred Generic	15.00									15.00													3
H5938	001	0	1	01	01	H5938_001_0	5	4	1	Speciality Brand/Generic	100100		1	Speciality Brand/Generic	010000000010000000000	30									30												Speciality Brand/Generic	2	1	010000000010000000000		Speciality Brand/Generic	10									10												Speciality Brand/Generic																							3
H5938	006	0	1	01	01	H5938_006_0	4	1	3	Preferred Generic	001000	1	2	Preferred Generic	010000000010000000000	30									30												Preferred Generic	2	2		010000000010000000000	Preferred Generic																						Preferred Generic	15.00									15.00												1	4
H5938	006	0	1	01	01	H5938_006_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5938	006	0	1	01	01	H5938_006_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H5938	006	0	1	01	01	H5938_006_0	4	4	1	Speciality Brand/Generic	100100	1	1	Speciality Brand/Generic	010000000010000000000	30									30												Speciality Brand/Generic	2	1	010000000010000000000		Speciality Brand/Generic	10									10												Speciality Brand/Generic																							4
H5938	006	0	1	01	01	H5938_006_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	1	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	50.00									50.00													4
H5938	006	0	1	01	01	H5938_006_0	4	4	3	Speciality Brand/Generic	100100	1	1	Speciality Brand/Generic																							Speciality Brand/Generic					Speciality Brand/Generic																						Speciality Brand/Generic																						2	4
H5938	006	0	1	01	01	H5938_006_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	010000000010000000000	30									30												Preferred Generic	2	2		010000000010000000000	Preferred Generic																						Preferred Generic	15.00									15.00													4
H5938	006	0	1	01	01	H5938_006_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	010000000010000000000	30									30												Preferred Brand	2	2		010000000010000000000	Preferred Brand																						Preferred Brand	30.00									30.00													4
H5943	001	0	1	39	05	H5943_001_0	11	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	6.00	12.00								10.00				12.00									3
H5943	001	0	1	39	05	H5943_001_0	11	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	31	90								31				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	60.00								40.00				60.00									3
H5943	001	0	1	39	05	H5943_001_0	11	3	1	Formulary Brand	010010		2	Formulary Brand	011000000010001000000	31	90								31				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	40.00	80.00								60.00				80.00									3
H5943	001	0	1	39	05	H5943_001_0	11	4	1	Formulary Specialty	010010		1	Formulary Specialty	010000000000100000000	31											10										Formulary Specialty	2	1	010000000000100000000		Formulary Specialty	25											25										Formulary Specialty																							3
H5948	001	0	1	01	01	H5948_001_0	8	1	1	Generics Preferred	011000	1	2	Generics Preferred	011000000010001000000	30	90								30				90								Generics Preferred	2	2		011000000010001000000	Generics Preferred																						Generics Preferred	0.00	10.00								5.00				10.00									4
H5948	001	0	1	01	01	H5948_001_0	8	4	1	Specialty Medications	111111	1	1	Specialty Medications	011000000010001000000	30	90								30				90								Specialty Medications	2	1	011000000010001000000		Specialty Medications	33	33								33				33								Specialty Medications																							4
H5948	001	0	1	01	01	H5948_001_0	8	2	1	Brand/Non Preferred Generics	000111	1	2	Brand/Non Preferred Generics	011000000010001000000	30	90								30				90								Brand/Non Preferred Generics	2	2		011000000010001000000	Brand/Non Preferred Generics																						Brand/Non Preferred Generics	35.00	70.00								70.00				70.00									4
H5948	001	0	1	01	01	H5948_001_0	8	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011000000010001000000	30	90								30				90								Non Preferred Brand	2	1	011000000010001000000		Non Preferred Brand	33	33								33				33								Non Preferred Brand																							4
H5948	002	0	1	01	01	H5948_002_0	7	1	3	Generic	011100	1	2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	0.00	0.00								0.00				0.00								1	4
H5948	002	0	1	01	01	H5948_002_0	7	2	3	Brand	100011	1	2	Brand																							Brand					Brand																						Brand																						2	4
H5950	001	0	1	01	01	H5950_001_0	5	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	33	33								33							33			33		Tier Three																							3
H5950	001	0	1	01	01	H5950_001_0	5	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	10.00	30.00								20.00							20.00			30.00			3
H5950	001	0	1	01	01	H5950_001_0	5	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	39.00	117.00								78.00							78.00			117.00			3
H5950	002	0	1	01	01	H5950_002_0	5	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H5950	002	0	1	01	01	H5950_002_0	5	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H5950	002	0	1	01	01	H5950_002_0	5	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H5950	002	0	1	01	01	H5950_002_0	5	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H5950	002	0	1	01	01	H5950_002_0	5	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H5950	002	0	1	01	01	H5950_002_0	5	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5950	002	0	1	01	01	H5950_002_0	5	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5950	002	0	1	01	01	H5950_002_0	5	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5950	003	0	1	01	01	H5950_003_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
H5950	003	0	1	01	01	H5950_003_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
H5950	003	0	1	01	01	H5950_003_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
H5950	003	0	1	01	01	H5950_003_0	4	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
H5950	003	0	1	01	01	H5950_003_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
H5950	003	0	1	01	01	H5950_003_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	55.00	165.00								110.00							110.00			165.00			4
H5950	003	0	1	01	01	H5950_003_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	25.00	75.00								50.00							50.00			75.00			4
H5950	003	0	1	01	01	H5950_003_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
H5952	001	0	1	09	04	H5952_001_0	3	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H5952	001	0	1	09	04	H5952_001_0	3	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
H5952	001	0	1	09	04	H5952_001_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5952	001	0	1	09	04	H5952_001_0	3	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00								1	4
H5952	001	0	1	09	04	H5952_001_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
H5952	001	0	1	09	04	H5952_001_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	60.00	180.00								60.00				120.00									4
H5952	001	0	1	09	04	H5952_001_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
H5952	001	0	1	09	04	H5952_001_0	3	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									4
H5969	001	0	1	01	01	H5969_001_0	7	1	1	Generic	011100	1	2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								7.50			5.00	15.00									4
H5969	001	0	1	01	01	H5969_001_0	7	2	1	Brand	100011	1	2	Brand	011000000010011000000	30	90								30			30	90								Brand	2	1	011000000010011000000		Brand	30	30								30			30	30								Brand																							4
H5969	001	0	1	01	01	H5969_001_0	7	3	1	Specialty	100011	1	1	Specialty	011000000010011000000	30	90								30			30	90								Specialty	2	1	011000000010011000000		Specialty	33	33								33			33	33								Specialty																							4
H5969	001	0	1	01	01	H5969_001_0	7	4	1	OTC	111111	1	2	OTC	011000000010011000000	30	90								30			30	90								OTC	2	2		011000000010011000000	OTC																						OTC	0.00	0.00								0.00			0.00	0.00									4
H5969	002	0	1	01	01	H5969_002_0	6	1	1	Generic	011100		2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	1	011000000010011000000		Generic	25	25								25			25	25								Generic																							3
H5969	002	0	1	01	01	H5969_002_0	6	2	1	Brand	100011		2	Brand	011000000010011000000	30	90								30			30	90								Brand	2	1	011000000010011000000		Brand	25	25								25			25	25								Brand																							3
H5969	002	0	1	01	01	H5969_002_0	6	3	1	OTC	111111		2	OTC	011000000010011000000	30	90								30			30	90								OTC	2	1	011000000010011000000		OTC	0	0								0			0	0								OTC																							3
H5980	002	0	1	01	01	H5980_002_0	20	1	1	Generic	010000	1	2	Generic	000010000010000000000				30						30												Generic	2	2		000010000010000000000	Generic																						Generic				5.00						5.00													4
H5980	002	0	1	01	01	H5980_002_0	20	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H5980	002	0	1	01	01	H5980_002_0	20	1	3	Generic	010000	1	2	Generic	000010000010000000000				30						30												Generic	2	2		000010000010000000000	Generic																						Generic				5.00						5.00												1	4
H5980	002	0	1	01	01	H5980_002_0	20	2	1	Brand	000010	1	2	Brand	000010000010000000000				30						30												Brand	2	1	000010000010000000000		Brand				25						25												Brand																							4
H5985	001	0	1	01	01	H5985_001_0	5	1	3	Tier 1 Generic/OTC	010000	1	2	Tier 1 Generic/OTC	000011000010000011000				30	90					30						30	90					Tier 1 Generic/OTC	2	2		000011000010000011000	Tier 1 Generic/OTC																						Tier 1 Generic/OTC				5.00	15.00					5.00						5.00	15.00					1	4
H5985	001	0	1	01	01	H5985_001_0	5	3	1	Tier 3, Non-preferred Brand	000100	1	2	Tier 3, Non-preferred Brand	000011000010000011000				30	90					30						30	90					Tier 3, Non-preferred Brand	2	2		000011000010000011000	Tier 3, Non-preferred Brand																						Tier 3, Non-preferred Brand				55.00	165.00					55.00						55.00	165.00						4
H5985	001	0	1	01	01	H5985_001_0	5	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	000011000010000011000				30	90					30						30	90					Tier 2 Preferred Brand	2	2		000011011010000011000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand				15.00	45.00		15.00	45.00		15.00						15.00	45.00						4
H5985	001	0	1	01	01	H5985_001_0	5	1	1	Tier 1 Generic/OTC	010000	1	2	Tier 1 Generic/OTC	000011011010000011000				30	90		30	90		30						30	90					Tier 1 Generic/OTC	2	2		000011011010000011000	Tier 1 Generic/OTC																						Tier 1 Generic/OTC				10.00	30.00		10.00	30.00		10.00						10.00	30.00						4
H5985	001	0	1	01	01	H5985_001_0	5	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
H5985	001	0	1	01	01	H5985_001_0	5	3	3	Tier 3, Non-preferred Brand	000100	1	2	Tier 3, Non-preferred Brand																							Tier 3, Non-preferred Brand					Tier 3, Non-preferred Brand																						Tier 3, Non-preferred Brand																						2	4
H5985	001	0	1	01	01	H5985_001_0	5	4	3	Tier 4 Specialty Drugs	000001	1	1	Tier 4 Specialty Drugs																							Tier 4 Specialty Drugs					Tier 4 Specialty Drugs																						Tier 4 Specialty Drugs																						2	4
H5985	001	0	1	01	01	H5985_001_0	5	4	1	Tier 4 Specialty Drugs	000001	1	1	Tier 4 Specialty Drugs	000011000010000011000				30	90					30						30	90					Tier 4 Specialty Drugs	2	1	000011000010000011000		Tier 4 Specialty Drugs				20	20					20						20	20					Tier 4 Specialty Drugs																							4
H5989	002	0	1	01	01	H5989_002_0	8	4	1	Tier 4 Speciality Drugs	010011		1	Tier 4 Speciality Drugs	011000000011011000000	30	90								30	90		30	90								Tier 4 Speciality Drugs	1	1	011000000011011000000		Tier 4 Speciality Drugs	25	25								25	25		25	25								Tier 4 Speciality Drugs																							3
H5989	002	0	1	01	01	H5989_002_0	8	2	1	Tier 2  Brands	000010		2	Tier 2  Brands	011000000011011000000	30	90								30	90		30	90								Tier 2  Brands	1	2		011000000011011000000	Tier 2  Brands																						Tier 2  Brands	35.00	105.00								35.00	105.00		35.00	70.00									3
H5989	002	0	1	01	01	H5989_002_0	8	3	1	Tier 3 Non-Preferred Brands	100000		2	Tier 3 Non-Preferred Brands	011000000011011000000	30	90								30	90		30	90								Tier 3 Non-Preferred Brands	1	2		011000000011011000000	Tier 3 Non-Preferred Brands																						Tier 3 Non-Preferred Brands	50.00	150.00								50.00	150.00		50.00	100.00									3
H5989	002	0	1	01	01	H5989_002_0	8	1	1	Tier 1 Generics	010000		2	Tier 1 Generics	011000000011011000000	30	90								30	90		30	90								Tier 1 Generics	1	2		011000000011011000000	Tier 1 Generics																						Tier 1 Generics	0.00	0.00								0.00	0.00		0.00	0.00									3
H5989	003	0	1	01	01	H5989_003_0	5	1	1	Tier 1 Generics	010000		2	Tier 1 Generics	011000000011011000000	30	90								30	90		30	90								Tier 1 Generics	1	2		011000000011011000000	Tier 1 Generics																						Tier 1 Generics	10.00	30.00								10.00	30.00		10.00	20.00									3
H5989	003	0	1	01	01	H5989_003_0	5	2	1	Tier 2 Preferred Brands	000001		2	Tier 2 Preferred Brands	011000000011011000000	30	90								30	90		30	90								Tier 2 Preferred Brands	1	2		011000000011011000000	Tier 2 Preferred Brands																						Tier 2 Preferred Brands	25.00	75.00								25.00	75.00		25.00	50.00									3
H5989	003	0	1	01	01	H5989_003_0	5	3	1	Tier 3 Non-Preferred Brands	100000		2	Tier 3 Non-Preferred Brands	011000000011011000000	30	90								30	90		30	90								Tier 3 Non-Preferred Brands	1	2		011000000011011000000	Tier 3 Non-Preferred Brands																						Tier 3 Non-Preferred Brands	40.00	120.00								40.00	120.00		40.00	80.00									3
H5989	003	0	1	01	01	H5989_003_0	5	4	1	Tier 4 Speciality	010010		1	Tier 4 Speciality	011000000011011000000	30	90								30	90		30	90								Tier 4 Speciality	1	1	011000000011011000000		Tier 4 Speciality	25	25								25	25		25	25								Tier 4 Speciality																							3
H5996	009	0	1	09	04	H5996_009_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
H5996	009	0	1	09	04	H5996_009_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	30		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	33.00	99.00	66.00							33.00	99.00	66.00		66.00	66.00								3
H5996	009	0	1	09	04	H5996_009_0	3	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	63.00	189.00	126.00							63.00	189.00	126.00		158.00	126.00								3
H5996	009	0	1	09	04	H5996_009_0	3	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
H5996	009	0	1	09	04	H5996_009_0	3	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
H5998	001	0	1	01	01	H5998_001_0	4	4	1	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Brand	2	2		011000000010001000000	Non-Preferred Generic/Brand																						Non-Preferred Generic/Brand	45.00	135.00								45.00				135.00									4
H5998	001	0	1	01	01	H5998_001_0	4	3	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H5998	001	0	1	01	01	H5998_001_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				12.00									4
H5998	001	0	1	01	01	H5998_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
H5998	002	0	1	01	01	H5998_002_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H5998	002	0	1	01	01	H5998_002_0	4	3	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H5998	002	0	1	01	01	H5998_002_0	4	4	3	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand																							Non-Preferred Generic/Brand					Non-Preferred Generic/Brand																						Non-Preferred Generic/Brand																						2	4
H5998	002	0	1	01	01	H5998_002_0	4	4	1	Non-Preferred Generic/Brand	100100	1	2	Non-Preferred Generic/Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Brand	2	2		011000000010001000000	Non-Preferred Generic/Brand																						Non-Preferred Generic/Brand	45.00	135.00								45.00				135.00									4
H5998	002	0	1	01	01	H5998_002_0	4	3	1	Specialty	010010	1	1	Specialty	011000000010001000000	30	90								30				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
H5998	002	0	1	01	01	H5998_002_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
H5998	002	0	1	01	01	H5998_002_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				12.00									4
H5998	002	0	1	01	01	H5998_002_0	4	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00				12.00								1	4
H6360	001	0	1	18	06	H6360_001_0	2	2	1	Brand	000010	1	2	Brand	011000000011011000000	31	90								31	90		31	90								Brand	2	2		011000000011011000000	Brand																						Brand	35.00	105.00								35.00	105.00		35.00	70.00									4
H6360	001	0	1	18	06	H6360_001_0	2	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
H6360	001	0	1	18	06	H6360_001_0	2	1	3	Generic	010000	1	2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	9.00	27.00								9.00	27.00		9.00	18.00								1	4
H6360	001	0	1	18	06	H6360_001_0	2	1	1	Generic	010000	1	2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	9.00	27.00								9.00	27.00		9.00	18.00									4
H6360	002	0	1	18	06	H6360_002_0	2	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	9.00	27.00								9.00	27.00		9.00	18.00									3
H6360	002	0	1	18	06	H6360_002_0	2	2	1	Brand	000010		2	Brand	011000000011011000000	31	90								31	90		31	90								Brand	2	2		011000000011011000000	Brand																						Brand	35.00	105.00								35.00	105.00		35.00	70.00									3
H6360	006	0	1	18	06	H6360_006_0	2	2	1	Brand	000010		2	Brand	011000000011011000000	31	90								31	90		31	90								Brand	2	2		011000000011011000000	Brand																						Brand	35.00	105.00								35.00	105.00		35.00	70.00									3
H6360	006	0	1	18	06	H6360_006_0	2	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	9.00	27.00								9.00	27.00		9.00	18.00									3
H6421	001	0	1	09	04	H6421_001_0	4	1	1	Generic	010000		2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
H6421	001	0	1	09	04	H6421_001_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00	87.00		29.00	58.00									3
H6421	001	0	1	09	04	H6421_001_0	4	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	55.00	165.00								55.00	165.00		55.00	110.00									3
H6421	001	0	1	09	04	H6421_001_0	4	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
H6499	006	0	1	09	04	H6499_006_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	006	0	1	09	04	H6499_006_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	006	0	1	09	04	H6499_006_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	006	0	1	09	04	H6499_006_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	007	0	1	09	04	H6499_007_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	007	0	1	09	04	H6499_007_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	007	0	1	09	04	H6499_007_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	007	0	1	09	04	H6499_007_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	008	0	1	09	04	H6499_008_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	008	0	1	09	04	H6499_008_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	008	0	1	09	04	H6499_008_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	008	0	1	09	04	H6499_008_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	009	0	1	09	04	H6499_009_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	009	0	1	09	04	H6499_009_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	009	0	1	09	04	H6499_009_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	009	0	1	09	04	H6499_009_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	010	0	1	09	04	H6499_010_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	010	0	1	09	04	H6499_010_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	010	0	1	09	04	H6499_010_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	010	0	1	09	04	H6499_010_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	011	0	1	09	04	H6499_011_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	011	0	1	09	04	H6499_011_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	011	0	1	09	04	H6499_011_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	011	0	1	09	04	H6499_011_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	012	0	1	09	04	H6499_012_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	64.00	192.00								64.00	192.00			192.00									4
H6499	012	0	1	09	04	H6499_012_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	012	0	1	09	04	H6499_012_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	54.00	162.00								54.00	162.00			162.00									4
H6499	012	0	1	09	04	H6499_012_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	013	0	1	09	04	H6499_013_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	013	0	1	09	04	H6499_013_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	013	0	1	09	04	H6499_013_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	013	0	1	09	04	H6499_013_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	014	0	1	09	04	H6499_014_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	014	0	1	09	04	H6499_014_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	014	0	1	09	04	H6499_014_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	014	0	1	09	04	H6499_014_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	015	0	1	09	04	H6499_015_0	5	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	015	0	1	09	04	H6499_015_0	5	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	015	0	1	09	04	H6499_015_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	015	0	1	09	04	H6499_015_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6499	016	0	1	09	04	H6499_016_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	58.00	174.00								58.00	174.00			174.00									4
H6499	016	0	1	09	04	H6499_016_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							4
H6499	016	0	1	09	04	H6499_016_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	28.00	84.00								28.00	84.00			84.00									4
H6499	016	0	1	09	04	H6499_016_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
H6717	001	0	1	02	01	H6717_001_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H6717	001	0	1	02	01	H6717_001_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H6717	001	0	1	02	01	H6717_001_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H6717	001	0	1	02	01	H6717_001_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H7187	001	0	1	02	01	H7187_001_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H7187	001	0	1	02	01	H7187_001_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H7187	001	0	1	02	01	H7187_001_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H7187	001	0	1	02	01	H7187_001_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H7187	002	0	1	02	01	H7187_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H7187	002	0	1	02	01	H7187_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H7187	002	0	1	02	01	H7187_002_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H7187	002	0	1	02	01	H7187_002_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H7187	003	0	1	02	01	H7187_003_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
H7187	003	0	1	02	01	H7187_003_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H7187	003	0	1	02	01	H7187_003_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
H7187	003	0	1	02	01	H7187_003_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H7226	001	0	1	09	04	H7226_001_0	5	2	1	Tier 2	010001	3	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	25.00	75.00								25.00	75.00			50.00									4
H7226	001	0	1	09	04	H7226_001_0	5	1	1	Tier 1	010001	3	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			20.00									4
H7226	001	0	1	09	04	H7226_001_0	5	3	1	Tier 3	000010	3	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	50.00	150.00								50.00	150.00			150.00									4
H7226	001	0	1	09	04	H7226_001_0	5	3	3	Tier 3	000010	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H7226	001	0	1	09	04	H7226_001_0	5	2	3	Tier 2	010001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H7226	001	0	1	09	04	H7226_001_0	5	1	3	Tier 1	010001	3	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			20.00								1	4
H7226	002	0	1	09	04	H7226_002_0	4	1	1	Tier 1	010001	3	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			20.00									4
H7226	002	0	1	09	04	H7226_002_0	4	2	1	Tier 2	010001	3	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00			60.00									4
H7226	002	0	1	09	04	H7226_002_0	4	3	1	Tier 3	000010	3	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	60.00	180.00								60.00	180.00			180.00									4
H7226	007	0	1	09	04	H7226_007_0	6	2	3	Tier 2	010001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H7226	007	0	1	09	04	H7226_007_0	6	1	3	Tier 1	010001	3	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			20.00								1	4
H7226	007	0	1	09	04	H7226_007_0	6	3	1	Tier 3	000010	3	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	50.00	150.00								50.00	150.00			150.00									4
H7226	007	0	1	09	04	H7226_007_0	6	2	1	Tier 2	010001	3	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	25.00	75.00								25.00	75.00			50.00									4
H7226	007	0	1	09	04	H7226_007_0	6	1	1	Tier 1	010001	3	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			20.00									4
H7226	007	0	1	09	04	H7226_007_0	6	3	3	Tier 3	000010	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H7226	008	0	1	09	04	H7226_008_0	4	1	1	Tier 1	010001	3	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			20.00									4
H7226	008	0	1	09	04	H7226_008_0	4	2	1	Tier 2	010001	3	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00			60.00									4
H7226	008	0	1	09	04	H7226_008_0	4	3	1	Tier 3	000010	3	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	60.00	180.00								60.00	180.00			180.00									4
H7254	001	0	1	02	01	H7254_001_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H7254	001	0	1	02	01	H7254_001_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
H7254	001	0	1	02	01	H7254_001_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H7254	001	0	1	02	01	H7254_001_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H7254	002	0	1	02	01	H7254_002_0	4	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H7254	002	0	1	02	01	H7254_002_0	4	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H7254	002	0	1	02	01	H7254_002_0	4	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H7254	002	0	1	02	01	H7254_002_0	4	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H7274	001	0	1	39	05	H7274_001_0	8	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							12.00			18.00			3
H7274	001	0	1	39	05	H7274_001_0	8	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			3
H7274	001	0	1	39	05	H7274_001_0	8	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H7274	001	0	1	39	05	H7274_001_0	8	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H7981	001	0	1	09	04	H7981_001_0	6	4	3	Specialty Drugs	110001	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H7981	001	0	1	09	04	H7981_001_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H7981	001	0	1	09	04	H7981_001_0	6	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									4
H7981	001	0	1	09	04	H7981_001_0	6	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00								1	4
H7981	001	0	1	09	04	H7981_001_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H7981	001	0	1	09	04	H7981_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	13.00	26.00								13.00	26.00			26.00									4
H7981	001	0	1	09	04	H7981_001_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	26.00	52.00								26.00	52.00			52.00									4
H7981	001	0	1	09	04	H7981_001_0	6	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							4
H7981	004	0	1	09	04	H7981_004_0	7	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	7.00	14.00								7.00	14.00			14.00									4
H7981	004	0	1	09	04	H7981_004_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	35.00	70.00								35.00	70.00			70.00									4
H7981	004	0	1	09	04	H7981_004_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	140.00								70.00	140.00			140.00									4
H7981	004	0	1	09	04	H7981_004_0	7	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							4
H8000	001	0	1	39	05	H8000_001_0	7	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H8000	001	0	1	39	05	H8000_001_0	7	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			3
H8000	001	0	1	39	05	H8000_001_0	7	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							12.00			18.00			3
H8000	001	0	1	39	05	H8000_001_0	7	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H8742	001	0	1	01	01	H8742_001_0	4	1	3	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00								1	4
H8742	001	0	1	01	01	H8742_001_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H8742	001	0	1	01	01	H8742_001_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H8742	001	0	1	01	01	H8742_001_0	4	4	1	Specialty	000010	1	1	Specialty	010000000010000000000	31									31												Specialty	2	1	010000000010000000000		Specialty	30									30												Specialty																							4
H8742	001	0	1	01	01	H8742_001_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	31	90								31			31	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
H8742	001	0	1	01	01	H8742_001_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H8742	001	0	1	01	01	H8742_001_0	4	1	1	Generic	010000	3	2	Generic	011000000010011000000	31	90								31			31	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	15.00								5.00			5.00	15.00									4
H8742	001	0	1	01	01	H8742_001_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	31	90								31			31	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	75.00									4
H9001	006	0	1	01	01	H9001_006_0	5	3	1	Tier 3	100000	3	2	Tier 3	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H9001	006	0	1	01	01	H9001_006_0	5	2	1	Tier 2	000101	3	2	Tier 2	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	20.00	60.00	40.00							20.00	60.00	40.00	20.00	60.00	40.00								4
H9001	006	0	1	01	01	H9001_006_0	5	1	1	Tier 1	001000	3	2	Tier 1	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	3.00	9.00	6.00							3.00	9.00	6.00	3.00	9.00	6.00								4
H9001	011	0	1	01	01	H9001_011_0	5	1	1	Tier 1	001000	3	2	Tier 1	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	3.00	9.00	6.00							3.00	9.00	6.00	3.00	9.00	6.00								4
H9001	011	0	1	01	01	H9001_011_0	5	3	1	Tier 3	100000	3	2	Tier 3	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H9001	011	0	1	01	01	H9001_011_0	5	2	1	Tier 2	000101	3	2	Tier 2	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	20.00	60.00	40.00							20.00	60.00	40.00	20.00	60.00	40.00								4
H9001	012	0	1	01	01	H9001_012_0	5	2	1	Tier 2	000101	3	2	Tier 2	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	20.00	60.00	40.00							20.00	60.00	40.00	20.00	60.00	40.00								4
H9001	012	0	1	01	01	H9001_012_0	5	3	1	Tier 3	100000	3	2	Tier 3	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H9001	012	0	1	01	01	H9001_012_0	5	1	1	Tier 1	001000	3	2	Tier 1	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	3.00	9.00	6.00							3.00	9.00	6.00	3.00	9.00	6.00								4
H9001	013	0	1	01	01	H9001_013_0	5	1	1	Tier 1	001000	3	2	Tier 1	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	3.00	9.00	6.00							3.00	9.00	6.00	3.00	9.00	6.00								4
H9001	013	0	1	01	01	H9001_013_0	5	3	1	Tier 3	100000	3	2	Tier 3	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H9001	013	0	1	01	01	H9001_013_0	5	2	1	Tier 2	000101	3	2	Tier 2	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	20.00	60.00	40.00							20.00	60.00	40.00	20.00	60.00	40.00								4
H9001	014	0	1	01	01	H9001_014_0	5	3	1	Tier 3	100000	3	2	Tier 3	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H9001	014	0	1	01	01	H9001_014_0	5	2	1	Tier 2	000101	3	2	Tier 2	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	20.00	60.00	40.00							20.00	60.00	40.00	20.00	60.00	40.00								4
H9001	014	0	1	01	01	H9001_014_0	5	1	1	Tier 1	001000	3	2	Tier 1	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	3.00	9.00	6.00							3.00	9.00	6.00	3.00	9.00	6.00								4
H9001	015	0	1	01	01	H9001_015_0	5	1	1	Tier 1	001000	3	2	Tier 1	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	3.00	9.00	6.00							3.00	9.00	6.00	3.00	9.00	6.00								4
H9001	015	0	1	01	01	H9001_015_0	5	3	1	Tier 3	100000	3	2	Tier 3	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H9001	015	0	1	01	01	H9001_015_0	5	2	1	Tier 2	000101	3	2	Tier 2	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	20.00	60.00	40.00							20.00	60.00	40.00	20.00	60.00	40.00								4
H9001	017	0	1	01	01	H9001_017_0	5	2	3	Tier 2	000101	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H9001	017	0	1	01	01	H9001_017_0	5	3	3	Tier 3	100000	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
H9001	017	0	1	01	01	H9001_017_0	5	1	1	Tier 1	001000	3	2	Tier 1	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	3.00	9.00	6.00							3.00	9.00	6.00	3.00	9.00	6.00								4
H9001	017	0	1	01	01	H9001_017_0	5	2	1	Tier 2	000101	3	2	Tier 2	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	20.00	60.00	40.00							20.00	60.00	40.00	20.00	60.00	40.00								4
H9001	017	0	1	01	01	H9001_017_0	5	3	1	Tier 3	100000	3	2	Tier 3	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
H9001	017	0	1	01	01	H9001_017_0	5	1	3	Tier 1	001000	3	2	Tier 1	011100000011111100000	30	90	60							30	90	60	30	90	60							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	3.00	9.00	6.00							3.00	9.00	6.00	3.00	9.00	6.00							1	4
H9003	001	0	1	01	01	H9003_001_0	7	1	1	Generic	010000		2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	15.00	45.00								15.00	45.00		15.00	30.00									3
H9003	001	0	1	01	01	H9003_001_0	7	2	1	Brand	000010		2	Brand	011000000011011000000	30	90								30	90		30	90								Brand	2	2		011000000011011000000	Brand																						Brand	40.00	120.00								40.00	120.00		40.00	80.00									3
H9011	003	0	1	01	01	H9011_003_0	5	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000010000001001	30	90								30							90			90		Tier 1 Generic	2	2		011000000010000001001	Tier 1 Generic																						Tier 1 Generic	0.00	0.00								0.00							0.00			0.00			4
H9011	003	0	1	01	01	H9011_003_0	5	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H9011	003	0	1	01	01	H9011_003_0	5	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
H9011	003	0	1	01	01	H9011_003_0	5	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H9011	003	0	1	01	01	H9011_003_0	5	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000010000001001	30	90								30							90			90		Tier 1 Generic	2	2		011000000010000001001	Tier 1 Generic																						Tier 1 Generic	0.00	0.00								0.00							0.00			0.00		1	4
H9011	003	0	1	01	01	H9011_003_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H9011	003	0	1	01	01	H9011_003_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	40.00	120.00								40.00							110.00			120.00			4
H9011	003	0	1	01	01	H9011_003_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	15.00	45.00								15.00							35.00			45.00			4
H9011	011	0	1	01	01	H9011_011_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H9011	011	0	1	01	01	H9011_011_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H9011	011	0	1	01	01	H9011_011_0	3	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H9011	011	0	1	01	01	H9011_011_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H9011	012	0	1	01	01	H9011_012_0	7	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000010000001001	30	90								30							90			90		Tier 1 Generic	2	2		011000000010000001001	Tier 1 Generic																						Tier 1 Generic	0.00	0.00								0.00							0.00			0.00		1	4
H9011	012	0	1	01	01	H9011_012_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H9011	012	0	1	01	01	H9011_012_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	40.00	120.00								40.00							110.00			120.00			4
H9011	012	0	1	01	01	H9011_012_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	15.00	45.00								15.00							35.00			45.00			4
H9011	012	0	1	01	01	H9011_012_0	7	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011000000010000001001	30	90								30							90			90		Tier 1 Generic	2	2		011000000010000001001	Tier 1 Generic																						Tier 1 Generic	0.00	0.00								0.00							0.00			0.00			4
H9011	012	0	1	01	01	H9011_012_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
H9011	012	0	1	01	01	H9011_012_0	7	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
H9011	012	0	1	01	01	H9011_012_0	7	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
H9016	002	0	1	01	01	H9016_002_0	8	4	1	Formulary High Cost	000011	1	1	Formulary High Cost	011000000010001000000	30	90								30				90								Formulary High Cost	1	1	011000000010001000000		Formulary High Cost	20	20								20				20								Formulary High Cost																							4
H9016	002	0	1	01	01	H9016_002_0	8	3	1	Formulary non Preferred Brand	100000	1	2	Formulary non Preferred Brand	011000000010001000000	30	90								30				90								Formulary non Preferred Brand	1	2		011000000010001000000	Formulary non Preferred Brand																						Formulary non Preferred Brand	40.00	80.00								40.00				80.00									4
H9016	002	0	1	01	01	H9016_002_0	8	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	1	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	16.00								8.00				16.00									4
H9016	002	0	1	01	01	H9016_002_0	8	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	1	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	15.00	30.00								15.00				30.00									4
H9016	006	0	1	01	01	H9016_006_0	9	3	1	Formulary non Preferred Brand	100000	1	2	Formulary non Preferred Brand	011000000010001000000	30	90								30				90								Formulary non Preferred Brand	1	2		011000000010001000000	Formulary non Preferred Brand																						Formulary non Preferred Brand	40.00	80.00								40.00				80.00									4
H9016	006	0	1	01	01	H9016_006_0	9	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	1	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	15.00	30.00								15.00				30.00									4
H9016	006	0	1	01	01	H9016_006_0	9	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	1	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	16.00								8.00				16.00									4
H9016	006	0	1	01	01	H9016_006_0	9	4	1	Formulary High Cost	000011	1	1	Formulary High Cost	011000000010001000000	30	90								30				90								Formulary High Cost	1	1	011000000010001000000		Formulary High Cost	20	20								20				20								Formulary High Cost																							4
H9016	007	0	1	01	01	H9016_007_0	9	4	1	Formulary High Cost	000011	1	1	Formulary High Cost	011000000010001000000	30	90								30				90								Formulary High Cost	1	1	011000000010001000000		Formulary High Cost	20	20								20				20								Formulary High Cost																							4
H9016	007	0	1	01	01	H9016_007_0	9	1	1	Formulary Generic	001000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	1	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	16.00								8.00				16.00									4
H9016	007	0	1	01	01	H9016_007_0	9	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	1	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	15.00	30.00								15.00				30.00									4
H9016	007	0	1	01	01	H9016_007_0	9	3	1	Formulary non Preferred Brand	100000	1	2	Formulary non Preferred Brand	011000000010001000000	30	90								30				90								Formulary non Preferred Brand	1	2		011000000010001000000	Formulary non Preferred Brand																						Formulary non Preferred Brand	40.00	80.00								40.00				80.00									4
H9047	001	0	1	01	01	H9047_001_0	9	1	1	Generic	010000		2	Generic	000011011010000011011				30	90		30	90		30						30	90		30	90		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	15.00		5.00	15.00		5.00						5.00	15.00		5.00	15.00			3
H9047	001	0	1	01	01	H9047_001_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	90		30	90		30						30	90		30	90		Brand	1	2		000011011010000011011	Brand																						Brand				30.00	80.00		30.00	90.00		30.00						30.00	80.00		30.00	90.00			3
H9047	001	0	1	01	01	H9047_001_0	9	3	1	Specialty	010010		1	Specialty	000010010010000010010				30			30			30						30			30			Specialty	1	1	000010010010000010010		Specialty				25			25			25						25			25			Specialty																							3
H9047	013	0	2	01	01	H9047_013_0	9	1	1	Generic	010000		2	Generic	000011011010000011011				30	90		30	90		30						30	90		30	90		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	15.00		5.00	15.00		5.00						5.00	15.00		5.00	15.00			3
H9047	013	0	2	01	01	H9047_013_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	90		30	90		30						30	90		30	90		Brand	1	2		000011011010000011011	Brand																						Brand				30.00	80.00		30.00	90.00		30.00						30.00	80.00		30.00	90.00			3
H9047	013	0	2	01	01	H9047_013_0	9	3	1	Specialty	010010		1	Specialty	000010010010000010010				30			30			30						30			30			Specialty	1	1	000010010010000010010		Specialty				25			25			25						25			25			Specialty																							3
H9047	024	0	1	02	01	H9047_024_0	9	1	1	Generic	010000		2	Generic	000011011010000011011				30	90		30	90		30						30	90		30	90		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	15.00		5.00	15.00		5.00						5.00	15.00		5.00	15.00			3
H9047	024	0	1	02	01	H9047_024_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	90		30	90		30						30	90		30	90		Brand	1	2		000011011010000011011	Brand																						Brand				30.00	80.00		30.00	90.00		30.00						30.00	80.00		30.00	90.00			3
H9047	024	0	1	02	01	H9047_024_0	9	3	1	Specialty	010010		1	Specialty	000010010010000010010				30			30			30						30			30			Specialty	1	1	000010010010000010010		Specialty				25			25			25						25			25			Specialty																							3
H9101	007	0	1	10	05	H9101_007_0	5	2	1	Preferred	000001	1	2	Preferred	011000000011001000000	30	90								30	90			90								Preferred	2	2		011000000011001000000	Preferred																						Preferred	25.00	75.00								25.00	75.00			62.50									4
H9101	007	0	1	10	05	H9101_007_0	5	3	1	Brand	100010	1	2	Brand	011000000011001000000	30	90								30	90			90								Brand	2	2		011000000011001000000	Brand																						Brand	60.00	180.00								60.00	180.00			150.00									4
H9101	007	0	1	10	05	H9101_007_0	5	4	1	Specialty	010010	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	3	011000000011001000000	011000000011001000000	Specialty	25	25								25	25			25								Specialty	60.00	180.00								60.00	180.00			150.00									4
H9101	007	0	1	10	05	H9101_007_0	5	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	0.00	0.00								0.00	0.00			0.00									4
H9103	001	0	1	10	05	H9103_001_0	6	2	3	Brand	000010	1	2	Brand	011000000011011000000	30	90								30	90		30	90								Brand	2	2		011000000011011000000	Brand																						Brand	40.00	120.00								40.00	120.00		40.00	80.00								1	4
H9103	001	0	1	10	05	H9103_001_0	6	1	3	Generic	010000	1	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	15.00	45.00								15.00	45.00		15.00	30.00								1	4
H9103	001	0	1	10	05	H9103_001_0	6	2	1	Brand	000010	1	2	Brand	011000000011011000000	30	90								30	90		30	90								Brand	2	2		011000000011011000000	Brand																						Brand	40.00	120.00								40.00	120.00		40.00	80.00									4
H9103	001	0	1	10	05	H9103_001_0	6	1	1	Generic	010000	1	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	2	2		011000000011011000000	Generic																						Generic	15.00	45.00								15.00	45.00		15.00	30.00									4
H9104	006	0	1	10	05	H9104_006_0	11	2	3	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H9104	006	0	1	10	05	H9104_006_0	11	2	1	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand	011000000010001000000	31	90								31				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	28.00	56.00								40.00				56.00									4
H9104	006	0	1	10	05	H9104_006_0	11	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H9104	006	0	1	10	05	H9104_006_0	11	3	3	Formulary Brand	010010	3	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H9104	006	0	1	10	05	H9104_006_0	11	3	1	Formulary Brand	010010	3	2	Formulary Brand	011000000010001000000	31	90								31				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	50.00	100.00								60.00				100.00									4
H9104	006	0	1	10	05	H9104_006_0	11	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	010000000000100000000	31											10										Formulary Specialty	2	1	010000000000100000000		Formulary Specialty	25											25										Formulary Specialty																							4
H9104	006	0	1	10	05	H9104_006_0	11	1	3	Formulary Generic	010000	3	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	10.00								10.00				10.00								1	4
H9104	006	0	1	10	05	H9104_006_0	11	1	1	Formulary Generic	010000	3	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	10.00								10.00				10.00									4
H9104	007	0	1	10	05	H9104_007_0	10	2	3	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H9104	007	0	1	10	05	H9104_007_0	10	1	1	Formulary Generic	010000	3	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	10.00								10.00				10.00									4
H9104	007	0	1	10	05	H9104_007_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H9104	007	0	1	10	05	H9104_007_0	10	3	3	Formulary Brand	010010	3	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H9104	007	0	1	10	05	H9104_007_0	10	2	1	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand	011000000010001000000	31	90								31				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	28.00	56.00								40.00				56.00									4
H9104	007	0	1	10	05	H9104_007_0	10	3	1	Formulary Brand	010010	3	2	Formulary Brand	011000000010001000000	31	90								31				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	50.00	100.00								60.00				100.00									4
H9104	007	0	1	10	05	H9104_007_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	010000000000100000000	31											10										Formulary Specialty	2	1	010000000000100000000		Formulary Specialty	25											25										Formulary Specialty																							4
H9104	007	0	1	10	05	H9104_007_0	10	1	3	Formulary Generic	010000	3	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	10.00								10.00				10.00								1	4
H9104	008	0	1	10	05	H9104_008_0	10	2	3	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H9104	008	0	1	10	05	H9104_008_0	10	3	3	Formulary Brand	010010	3	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H9104	008	0	1	10	05	H9104_008_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H9104	008	0	1	10	05	H9104_008_0	10	1	3	Formulary Generic	010000	3	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	25.00								15.00				25.00								1	4
H9104	008	0	1	10	05	H9104_008_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	010000000000100000000	31											10										Formulary Specialty	2	1	010000000000100000000		Formulary Specialty	25											25										Formulary Specialty																							4
H9104	008	0	1	10	05	H9104_008_0	10	3	1	Formulary Brand	010010	3	2	Formulary Brand	011000000010001000000	31	90								31				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	50.00	125.00								60.00				125.00									4
H9104	008	0	1	10	05	H9104_008_0	10	2	1	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand	011000000010001000000	31	90								31				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	75.00								40.00				75.00									4
H9104	008	0	1	10	05	H9104_008_0	10	1	1	Formulary Generic	010000	3	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	25.00								15.00				25.00									4
H9104	009	0	1	10	05	H9104_009_0	10	1	1	Formulary Generic	010000	3	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	25.00								15.00				25.00									4
H9104	009	0	1	10	05	H9104_009_0	10	2	1	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand	011000000010001000000	31	90								31				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	30.00	75.00								40.00				75.00									4
H9104	009	0	1	10	05	H9104_009_0	10	3	1	Formulary Brand	010010	3	2	Formulary Brand	011000000010001000000	31	90								31				90								Formulary Brand	2	2		011000000010001000000	Formulary Brand																						Formulary Brand	50.00	125.00								60.00				125.00									4
H9104	009	0	1	10	05	H9104_009_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	010000000000100000000	31											10										Formulary Specialty	2	1	010000000000100000000		Formulary Specialty	25											25										Formulary Specialty																							4
H9104	009	0	1	10	05	H9104_009_0	10	1	3	Formulary Generic	010000	3	2	Formulary Generic	011000000010001000000	31	90								31				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	10.00	25.00								15.00				25.00								1	4
H9104	009	0	1	10	05	H9104_009_0	10	2	3	Formulary Preferred Brand	000001	3	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H9104	009	0	1	10	05	H9104_009_0	10	3	3	Formulary Brand	010010	3	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H9104	009	0	1	10	05	H9104_009_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
H9136	001	0	1	01	01	H9136_001_0	7	1	1	Formulary Generic	011000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	1	2		011000000010001000000	Formulary Generic																						Formulary Generic	8.00	16.00								8.00				16.00									4
H9136	001	0	1	01	01	H9136_001_0	7	4	1	Formulary High Cost	000001	1	1	Formulary High Cost	011000000010001000000	30	90								30				90								Formulary High Cost	1	1	011000000010001000000		Formulary High Cost	20	20								20				20								Formulary High Cost																							4
H9136	001	0	1	01	01	H9136_001_0	7	3	1	Formulary Non-Preferred	100000	1	2	Formulary Non-Preferred	011000000010001000000	30	90								30				90								Formulary Non-Preferred	1	2		011000000010001000000	Formulary Non-Preferred																						Formulary Non-Preferred	40.00	80.00								40.00				80.00									4
H9136	001	0	1	01	01	H9136_001_0	7	2	1	Formulary Preferred Brand	001001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	1	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	15.00	30.00								15.00				30.00									4
H9313	001	0	1	01	01	H9313_001_0	2	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00									3
H9313	001	0	1	01	01	H9313_001_0	2	4	1	Specialty	110001		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
H9313	001	0	1	01	01	H9313_001_0	2	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	75	75								75	75			75								Non-Preferred Brand																							3
H9313	001	0	1	01	01	H9313_001_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			80.00									3
H9313	002	0	1	02	01	H9313_002_0	2	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00								1	4
H9313	002	0	1	02	01	H9313_002_0	2	4	1	Specialty	110001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H9313	002	0	1	02	01	H9313_002_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	75	75								75	75			75								Non-Preferred Brand																							4
H9313	002	0	1	02	01	H9313_002_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			80.00									4
H9313	002	0	1	02	01	H9313_002_0	2	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00									4
H9313	002	0	1	02	01	H9313_002_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H9313	002	0	1	02	01	H9313_002_0	2	4	3	Specialty	110001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H9313	002	0	1	02	01	H9313_002_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H9313	003	0	1	02	01	H9313_003_0	2	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00									4
H9313	003	0	1	02	01	H9313_003_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			80.00									4
H9313	003	0	1	02	01	H9313_003_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	75	75								75	75			75								Non-Preferred Brand																							4
H9313	003	0	1	02	01	H9313_003_0	2	4	1	Specialty	110001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
H9313	003	0	1	02	01	H9313_003_0	2	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00								1	4
H9313	003	0	1	02	01	H9313_003_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
H9313	003	0	1	02	01	H9313_003_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
H9313	003	0	1	02	01	H9313_003_0	2	4	3	Specialty	110001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
H9418	001	0	1	02	01	H9418_001_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			3
H9418	001	0	1	02	01	H9418_001_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	30.00	90.00								30.00							80.00			90.00			3
H9418	001	0	1	02	01	H9418_001_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			3
H9418	001	0	1	02	01	H9418_001_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
H9418	002	0	1	02	01	H9418_002_0	6	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
H9418	002	0	1	02	01	H9418_002_0	6	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
H9418	002	0	1	02	01	H9418_002_0	6	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
H9418	002	0	1	02	01	H9418_002_0	6	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
H9519	001	0	1	09	04	H9519_001_0	10	4	3	Specialty Drugs	111111	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
H9519	001	0	1	09	04	H9519_001_0	10	5	3	OTC	000010	1	2	OTC	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		OTC	2	2		011011011011001001001	OTC																						OTC	0.00	0.00		0.00	0.00		0.00	0.00		0.00	0.00			0.00			0.00			0.00		1	4
H9519	001	0	1	09	04	H9519_001_0	10	1	1	Formulary Generic	011100	1	2	Formulary Generic	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		Formulary Generic	2	2		011011011011001001001	Formulary Generic																						Formulary Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00			15.00			15.00			15.00			4
H9519	001	0	1	09	04	H9519_001_0	10	2	1	Formulary Preferred Brand	000011	1	2	Formulary Preferred Brand	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		Formulary Preferred Brand	2	2		011011011011001001001	Formulary Preferred Brand																						Formulary Preferred Brand	20.00	60.00		20.00	60.00		20.00	60.00		20.00	60.00			60.00			60.00			60.00			4
H9519	001	0	1	09	04	H9519_001_0	10	3	3	Formulary Brand	100011	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
H9519	001	0	1	09	04	H9519_001_0	10	4	1	Specialty Drugs	111111	1	1	Specialty Drugs	000010000010000000000				30						30												Specialty Drugs	2	1	000010000010000000000		Specialty Drugs				25						25												Specialty Drugs																							4
H9519	001	0	1	09	04	H9519_001_0	10	5	1	OTC	000010	1	2	OTC	010010010010000000000	30			30			30			30												OTC	2	2		010010010010000000000	OTC																						OTC	0.00			0.00			0.00			0.00													4
H9519	001	0	1	09	04	H9519_001_0	10	1	3	Formulary Generic	011100	1	2	Formulary Generic	011011011011001001001	30	90		30	90		30	90		30	90			30			90			90		Formulary Generic	2	2		011011011011001001001	Formulary Generic																						Formulary Generic	5.00	15.00		5.00	15.00		5.00	15.00		5.00	15.00			15.00			15.00			15.00		1	4
H9519	001	0	1	09	04	H9519_001_0	10	2	3	Formulary Preferred Brand	000011	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
H9519	001	0	1	09	04	H9519_001_0	10	3	1	Formulary Brand	100011	1	2	Formulary Brand	011011011011001001001	30	90		30	90		30	90		30	90			90			90			90		Formulary Brand	2	2		011011011011001001001	Formulary Brand																						Formulary Brand	35.00	105.00		35.00	105.00		35.00	105.00		35.00	105.00			105.00			105.00			105.00			4
H9859	002	0	1	01	01	H9859_002_0	11	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	34	90								34	90		34	90								Tier 1	1	2		011000000011011000000	Tier 1																						Tier 1	8.00	24.00								8.00	24.00		16.00	16.00									3
H9859	002	0	1	01	01	H9859_002_0	11	2	1	Tier 2	000010		1	Tier 2	011000000011011000000	34	90								34	90		34	90								Tier 2	1	2		011000000011011000000	Tier 2																						Tier 2	40.00	120.00								40.00	120.00		80.00	80.00									3
H9859	002	0	1	01	01	H9859_002_0	11	3	1	Tier 3	000010		1	Tier 3	011000000011011000000	34	90								34	90		34	90								Tier 3	2	1	011000000011011000000		Tier 3	25	25								25	25		25	25								Tier 3																							3
H9859	004	0	1	01	01	H9859_004_0	11	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	34	90								34	90		34	90								Tier 1	1	2		011000000011011000000	Tier 1																						Tier 1	8.00	24.00								8.00	24.00		16.00	16.00									3
H9859	004	0	1	01	01	H9859_004_0	11	2	1	Tier 2	000010		1	Tier 2	011000000011011000000	34	90								34	90		34	90								Tier 2	1	2		011000000011011000000	Tier 2																						Tier 2	40.00	120.00								40.00	120.00		80.00	80.00									3
H9859	004	0	1	01	01	H9859_004_0	11	3	1	Tier 3	000010		1	Tier 3	011000000011011000000	34	90								34	90		34	90								Tier 3	2	1	011000000011011000000		Tier 3	25	25								25	25		25	25								Tier 3																							3
H9859	006	0	1	01	01	H9859_006_0	12	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	34	90								34	90		34	90								Tier 1	1	2		011000000011011000000	Tier 1																						Tier 1	8.00	24.00								8.00	24.00		16.00	16.00									3
H9859	006	0	1	01	01	H9859_006_0	12	2	1	Tier 2	000010		1	Tier 2	011000000011011000000	34	90								34	90		34	90								Tier 2	1	2		011000000011011000000	Tier 2																						Tier 2	40.00	120.00								40.00	120.00		80.00	80.00									3
H9859	006	0	1	01	01	H9859_006_0	12	3	1	Tier 3	000010		1	Tier 3	011000000011011000000	34	90								34	90		34	90								Tier 3	2	1	011000000011011000000		Tier 3	25	25								25	25		25	25								Tier 3																							3
H9984	001	0	1	01	01	H9984_001_0	8	3	1	PA	100000		2	PA	011000000010000000000	30	90								30												PA	2	2		011000000010000000000	PA																						PA	45.00	135.00								100.00													3
H9984	001	0	1	01	01	H9984_001_0	8	2	1	Non-Preferred	000001		2	Non-Preferred	011000000010000000000	30	90								30												Non-Preferred	2	2		011000000010000000000	Non-Preferred																						Non-Preferred	25.00	75.00								50.00													3
H9984	001	0	1	01	01	H9984_001_0	8	1	1	Preferred	010000		2	Preferred	011000000010000000000	30	90								30												Preferred	2	2		011000000010000000000	Preferred																						Preferred	3.00	9.00								15.00													3
H9984	001	0	1	01	01	H9984_001_0	8	4	1	Specialty	100000		1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							3
H9984	002	0	1	01	01	H9984_002_0	5	3	1	PA	100000	1	2	PA	011000000010000000000	30	90								30												PA	2	2		011000000010000000000	PA																						PA	50.00	150.00								50.00													4
H9984	002	0	1	01	01	H9984_002_0	5	2	1	Non-Preferred	000001	1	2	Non-Preferred	011000000010000000000	30	90								30												Non-Preferred	2	2		011000000010000000000	Non-Preferred																						Non-Preferred	20.00	60.00								20.00													4
H9984	002	0	1	01	01	H9984_002_0	5	1	1	Preferred	010000	1	2	Preferred	011000000010000000000	30	90								30												Preferred	2	2		011000000010000000000	Preferred																						Preferred	3.00	9.00								3.00													4
H9984	002	0	1	01	01	H9984_002_0	5	4	1	Specialty	100000	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
H9984	003	0	1	01	01	H9984_003_0	4	1	1	Preferred	010000	1	2	Preferred	011000000010000000000	30	90								30												Preferred	2	2		011000000010000000000	Preferred																						Preferred	0.00	0.00								0.00													4
H9984	003	0	1	01	01	H9984_003_0	4	2	1	Non-Preferred	000001	1	2	Non-Preferred	011000000010000000000	30	90								30												Non-Preferred	2	2		011000000010000000000	Non-Preferred																						Non-Preferred	15.00	45.00								15.00													4
H9984	003	0	1	01	01	H9984_003_0	4	3	1	PA	100000	1	2	PA	011000000010000000000	30	90								30												PA	2	2		011000000010000000000	PA																						PA	30.00	90.00								30.00													4
H9984	003	0	1	01	01	H9984_003_0	4	4	1	Specialty	100000	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
H9984	003	0	1	01	01	H9984_003_0	4	1	3	Preferred	010000	1	2	Preferred	011000000010000000000	30	90								30												Preferred	2	2		011000000010000000000	Preferred																						Preferred	0.00	0.00								0.00												1	4
H9984	003	0	1	01	01	H9984_003_0	4	2	3	Non-Preferred	000001	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
H9984	003	0	1	01	01	H9984_003_0	4	3	3	PA	100000	1	2	PA																							PA					PA																						PA																						2	4
H9984	003	0	1	01	01	H9984_003_0	4	4	3	Specialty	100000	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
R3175	001	0	1	31	11	R3175_001_0	5	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
R3175	001	0	1	31	11	R3175_001_0	5	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
R3175	001	0	1	31	11	R3175_001_0	5	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
R3175	001	0	1	31	11	R3175_001_0	5	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
R3175	003	0	1	31	11	R3175_003_0	9	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
R3175	003	0	1	31	11	R3175_003_0	9	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
R3175	003	0	1	31	11	R3175_003_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
R3175	003	0	1	31	11	R3175_003_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
R3444	001	0	1	31	11	R3444_001_0	9	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00				0.00									3
R3444	001	0	1	31	11	R3444_001_0	9	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	40.00	120.00								40.00				120.00									3
R3444	001	0	1	31	11	R3444_001_0	9	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
R3444	001	0	1	31	11	R3444_001_0	9	3	1	Formulary Non Preferred Brand	100000		2	Formulary Non Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non Preferred Brand	2	2		011000000010001000000	Formulary Non Preferred Brand																						Formulary Non Preferred Brand	58.00	174.00								58.00				174.00									3
R3444	002	0	1	31	11	R3444_002_0	11	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									3
R3444	002	0	1	31	11	R3444_002_0	11	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	24.00	72.00								24.00				72.00									3
R3444	002	0	1	31	11	R3444_002_0	11	3	1	Formulary Non Preferred Brand	100000		2	Formulary Non Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non Preferred Brand	2	2		011000000010001000000	Formulary Non Preferred Brand																						Formulary Non Preferred Brand	51.00	153.00								51.00				153.00									3
R3444	002	0	1	31	11	R3444_002_0	11	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
R3444	003	0	1	31	11	R3444_003_0	11	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									3
R3444	003	0	1	31	11	R3444_003_0	11	3	1	Formulary Non Preferred Brand	100000		2	Formulary Non Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non Preferred Brand	2	2		011000000010001000000	Formulary Non Preferred Brand																						Formulary Non Preferred Brand	51.00	153.00								51.00				153.00									3
R3444	003	0	1	31	11	R3444_003_0	11	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	24.00	72.00								24.00				72.00									3
R3444	003	0	1	31	11	R3444_003_0	11	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
R3444	004	0	1	31	11	R3444_004_0	12	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R3444	004	0	1	31	11	R3444_004_0	12	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R3444	004	0	1	31	11	R3444_004_0	12	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R3444	004	0	1	31	11	R3444_004_0	12	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00								1	4
R3444	004	0	1	31	11	R3444_004_0	12	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R3444	004	0	1	31	11	R3444_004_0	12	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R3444	004	0	1	31	11	R3444_004_0	12	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	51.00	153.00								51.00				153.00									4
R3444	004	0	1	31	11	R3444_004_0	12	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	24.00	72.00								24.00				72.00									4
R3444	004	0	1	31	11	R3444_004_0	12	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
R3444	004	0	1	31	11	R3444_004_0	12	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R3444	005	0	1	31	11	R3444_005_0	12	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R3444	005	0	1	31	11	R3444_005_0	12	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	51.00	153.00								51.00				153.00									4
R3444	005	0	1	31	11	R3444_005_0	12	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	24.00	72.00								24.00				72.00									4
R3444	005	0	1	31	11	R3444_005_0	12	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
R3444	005	0	1	31	11	R3444_005_0	12	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R3444	005	0	1	31	11	R3444_005_0	12	1	3	Formulary Generic	010000	1	2	Formulary Generic																							Formulary Generic					Formulary Generic																						Formulary Generic																						2	4
R3444	005	0	1	31	11	R3444_005_0	12	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R3444	005	0	1	31	11	R3444_005_0	12	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R3444	005	0	1	31	11	R3444_005_0	12	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R3444	005	0	1	31	11	R3444_005_0	12	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R3444	006	0	1	31	11	R3444_006_0	12	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R3444	006	0	1	31	11	R3444_006_0	12	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	51.00	153.00								51.00				153.00									4
R3444	006	0	1	31	11	R3444_006_0	12	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	24.00	72.00								24.00				72.00									4
R3444	006	0	1	31	11	R3444_006_0	12	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
R3444	006	0	1	31	11	R3444_006_0	12	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R3444	006	0	1	31	11	R3444_006_0	12	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R3444	006	0	1	31	11	R3444_006_0	12	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R3444	006	0	1	31	11	R3444_006_0	12	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R3444	006	0	1	31	11	R3444_006_0	12	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R3444	006	0	1	31	11	R3444_006_0	12	1	3	Formulary Generic	010000	1	2	Formulary Generic																							Formulary Generic					Formulary Generic																						Formulary Generic																						2	4
R3444	007	0	1	31	11	R3444_007_0	12	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
R3444	007	0	1	31	11	R3444_007_0	12	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	24.00	72.00								24.00				72.00									4
R3444	007	0	1	31	11	R3444_007_0	12	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	51.00	153.00								51.00				153.00									4
R3444	007	0	1	31	11	R3444_007_0	12	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R3444	007	0	1	31	11	R3444_007_0	12	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R3444	007	0	1	31	11	R3444_007_0	12	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R3444	007	0	1	31	11	R3444_007_0	12	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R3444	007	0	1	31	11	R3444_007_0	12	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00								1	4
R3444	007	0	1	31	11	R3444_007_0	12	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R3444	007	0	1	31	11	R3444_007_0	12	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R5287	001	0	1	31	11	R5287_001_0	9	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
R5287	001	0	1	31	11	R5287_001_0	9	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
R5287	001	0	1	31	11	R5287_001_0	9	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
R5287	001	0	1	31	11	R5287_001_0	9	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
R5287	003	0	1	31	11	R5287_003_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
R5287	003	0	1	31	11	R5287_003_0	8	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
R5287	003	0	1	31	11	R5287_003_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
R5287	003	0	1	31	11	R5287_003_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
R5342	001	0	1	31	11	R5342_001_0	8	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	58.00	174.00								58.00							164.00			174.00			4
R5342	001	0	1	31	11	R5342_001_0	8	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							74.00			84.00			4
R5342	001	0	1	31	11	R5342_001_0	8	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	4.00	12.00								4.00							8.00			12.00			4
R5342	001	0	1	31	11	R5342_001_0	8	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
R5342	003	0	1	31	11	R5342_003_0	7	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	30	90								30							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
R5342	003	0	1	31	11	R5342_003_0	7	2	1	Tier 2	000001	1	2	Tier 2	011000000010000001001	30	90								30							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	35.00	105.00								35.00							95.00			105.00			4
R5342	003	0	1	31	11	R5342_003_0	7	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	30	90								30							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.00	195.00								65.00							185.00			195.00			4
R5342	003	0	1	31	11	R5342_003_0	7	1	1	Tier 1	010000	1	2	Tier 1	011000000010000001001	30	90								30							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							10.00			15.00			4
R5553	001	0	1	31	11	R5553_001_0	9	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
R5553	001	0	1	31	11	R5553_001_0	9	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	115.00								46.00				92.00									3
R5553	001	0	1	31	11	R5553_001_0	9	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									3
R5553	001	0	1	31	11	R5553_001_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									3
R5553	002	0	1	31	11	R5553_002_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
R5553	002	0	1	31	11	R5553_002_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
R5553	002	0	1	31	11	R5553_002_0	7	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00								1	4
R5553	002	0	1	31	11	R5553_002_0	7	4	1	Specialty	000010	1	1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
R5553	002	0	1	31	11	R5553_002_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	115.00								46.00				92.00									4
R5553	002	0	1	31	11	R5553_002_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	65.00								26.00				52.00									4
R5553	002	0	1	31	11	R5553_002_0	7	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									4
R5553	002	0	1	31	11	R5553_002_0	7	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
R5566	003	0	1	31	11	R5566_003_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	23.00	69.00								23.00				46.00									2
R5566	003	0	1	31	11	R5566_003_0	2	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				10.00									2
R5566	003	0	1	31	11	R5566_003_0	2	3	1	Specialty	010001		1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							2
R5566	005	0	1	31	11	R5566_005_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	23.00	69.00								23.00				46.00									2
R5566	005	0	1	31	11	R5566_005_0	2	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				10.00									2
R5566	005	0	1	31	11	R5566_005_0	2	3	1	Specialty	010001		1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	25	25								25				25								Specialty																							2
R5566	006	0	1	31	11	R5566_006_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									4
R5566	006	0	1	31	11	R5566_006_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				10.00									4
R5566	006	0	1	31	11	R5566_006_0	2	3	1	Brand	100000	1	2	Brand	011000000010001000000	31	90								31				90								Brand	2	1	011000000010001000000		Brand	50	50								50				50								Brand																							4
R5566	006	0	1	31	11	R5566_006_0	2	4	1	Specialty	010010	1	1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
R5566	008	0	1	31	11	R5566_008_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	1	011000000010001000000		Generic	30	30								30				30								Generic																							4
R5566	008	0	1	31	11	R5566_008_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	1	011000000010001000000		Preferred Brand	30	30								30				30								Preferred Brand																							4
R5566	008	0	1	31	11	R5566_008_0	2	3	1	Brand	100000	1	2	Brand	011000000010001000000	31	90								31				90								Brand	2	1	011000000010001000000		Brand	30	30								30				30								Brand																							4
R5566	008	0	1	31	11	R5566_008_0	2	4	1	Specialty	010010	1	1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	30	30								30				30								Specialty																							4
R5595	001	0	1	31	11	R5595_001_0	3	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
R5595	001	0	1	31	11	R5595_001_0	3	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
R5595	001	0	1	31	11	R5595_001_0	3	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
R5595	003	0	1	31	11	R5595_003_0	4	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				10.00	25.00		10.00	30.00		20.00							20.00			30.00			3
R5595	003	0	1	31	11	R5595_003_0	4	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				33	33		33	33		33							33			33		Tier Three																							3
R5595	003	0	1	31	11	R5595_003_0	4	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				40.00	100.00		40.00	120.00		80.00							80.00			120.00			3
R5595	004	0	1	31	11	R5595_004_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
R5595	004	0	1	31	11	R5595_004_0	4	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
R5595	004	0	1	31	11	R5595_004_0	4	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
R5595	004	0	1	31	11	R5595_004_0	4	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
R5595	004	0	1	31	11	R5595_004_0	4	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
R5595	004	0	1	31	11	R5595_004_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
R5595	004	0	1	31	11	R5595_004_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
R5595	004	0	1	31	11	R5595_004_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
R5674	001	0	1	31	11	R5674_001_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	3.00	9.00								3.00				9.00									3
R5674	001	0	1	31	11	R5674_001_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				60.00									3
R5674	001	0	1	31	11	R5674_001_0	9	3	1	Specialty Tier	010010		1	Specialty Tier	011000000010001000000	30	90								30				90								Specialty Tier	2	1	011000000010001000000		Specialty Tier	25	25								25				25								Specialty Tier																							3
R5826	001	0	1	31	11	R5826_001_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	001	0	1	31	11	R5826_001_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	001	0	1	31	11	R5826_001_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	001	0	1	31	11	R5826_001_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	002	0	1	31	11	R5826_002_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	002	0	1	31	11	R5826_002_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	002	0	1	31	11	R5826_002_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	002	0	1	31	11	R5826_002_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	003	0	1	31	11	R5826_003_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	003	0	1	31	11	R5826_003_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	003	0	1	31	11	R5826_003_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	003	0	1	31	11	R5826_003_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	004	0	1	31	11	R5826_004_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	004	0	1	31	11	R5826_004_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	004	0	1	31	11	R5826_004_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	004	0	1	31	11	R5826_004_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	005	0	1	31	11	R5826_005_0	5	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	005	0	1	31	11	R5826_005_0	5	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	005	0	1	31	11	R5826_005_0	5	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	005	0	1	31	11	R5826_005_0	5	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	006	0	1	31	11	R5826_006_0	5	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	006	0	1	31	11	R5826_006_0	5	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00			32.00	80.00									3
R5826	006	0	1	31	11	R5826_006_0	5	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	64.00	192.00								64.00			64.00	160.00									3
R5826	006	0	1	31	11	R5826_006_0	5	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	007	0	1	31	11	R5826_007_0	5	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	007	0	1	31	11	R5826_007_0	5	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	007	0	1	31	11	R5826_007_0	5	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	007	0	1	31	11	R5826_007_0	5	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	008	0	1	31	11	R5826_008_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	008	0	1	31	11	R5826_008_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	008	0	1	31	11	R5826_008_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	008	0	1	31	11	R5826_008_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	009	0	1	31	11	R5826_009_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	009	0	1	31	11	R5826_009_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	64.00	192.00								64.00			64.00	160.00									3
R5826	009	0	1	31	11	R5826_009_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00			32.00	80.00									3
R5826	009	0	1	31	11	R5826_009_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	010	0	1	31	11	R5826_010_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00			32.00	80.00									3
R5826	010	0	1	31	11	R5826_010_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	010	0	1	31	11	R5826_010_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	64.00	192.00								64.00			64.00	160.00									3
R5826	010	0	1	31	11	R5826_010_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	011	0	1	31	11	R5826_011_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	011	0	1	31	11	R5826_011_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	011	0	1	31	11	R5826_011_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	011	0	1	31	11	R5826_011_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	012	0	1	31	11	R5826_012_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5826	012	0	1	31	11	R5826_012_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	012	0	1	31	11	R5826_012_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	012	0	1	31	11	R5826_012_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	013	0	1	31	11	R5826_013_0	6	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	32.50	97.50								32.50			32.50	81.25									3
R5826	013	0	1	31	11	R5826_013_0	6	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	6.00	18.00								6.00			6.00	15.00									3
R5826	013	0	1	31	11	R5826_013_0	6	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	64.50	193.50								64.50			64.50	161.25									3
R5826	013	0	1	31	11	R5826_013_0	6	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	014	0	1	31	11	R5826_014_0	9	4	1	Specialty	100100		1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
R5826	014	0	1	31	11	R5826_014_0	9	3	1	Other-Non-Preferred	100100		2	Other-Non-Preferred	011000000010011000000	30	90								30			30	90								Other-Non-Preferred	2	2		011000000010011000000	Other-Non-Preferred																						Other-Non-Preferred	65.00	195.00								65.00			65.00	162.50									3
R5826	014	0	1	31	11	R5826_014_0	9	2	1	Preferred Brand	000011		2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	35.00	105.00								35.00			35.00	87.50									3
R5826	014	0	1	31	11	R5826_014_0	9	1	1	Preferred Generic	011000		2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									3
R5863	001	0	1	31	11	R5863_001_0	10	4	1	Tier 4 Injectables	010010	1	1	Tier 4 Injectables	011011011010000000000	30	90		30	90		30	90		30												Tier 4 Injectables	1	1	011011011010000000000		Tier 4 Injectables	33	33		33	33		33	33		33												Tier 4 Injectables																							4
R5863	001	0	1	31	11	R5863_001_0	10	3	1	Tier 3	100100	1	2	Tier 3	011011011010001000000	30	90		30	90		30	90		30				90								Tier 3	1	2		011011011010001000000	Tier 3																						Tier 3	78.00	234.00		78.00	234.00		78.00	234.00		78.00				195.00									4
R5863	001	0	1	31	11	R5863_001_0	10	2	1	Tier 2	000001	1	2	Tier 2	011011011010001000000	30	90		30	90		30	90		30				90								Tier 2	1	2		011011011010001000000	Tier 2																						Tier 2	39.00	117.00		39.00	117.00		39.00	117.00		39.00				78.00									4
R5863	001	0	1	31	11	R5863_001_0	10	5	1	Tier 5 Specialty	010010	1	1	Tier 5 Specialty	011011011010000000000	30	90		30	90		30	90		30												Tier 5 Specialty	1	1	011011011010000000000		Tier 5 Specialty	33	33		33	33		33	33		33												Tier 5 Specialty																							4
R5863	001	0	1	31	11	R5863_001_0	10	1	1	Tier 1	001000	1	2	Tier 1	011011011010001000000	30	90		30	90		30	90		30				90								Tier 1	1	2		011011011010001000000	Tier 1																						Tier 1	0.00	0.00		0.00	0.00		0.00	0.00		0.00				0.00									4
R5941	001	0	1	31	11	R5941_001_0	10	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
R5941	001	0	1	31	11	R5941_001_0	10	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
R5941	001	0	1	31	11	R5941_001_0	10	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
R5941	001	0	1	31	11	R5941_001_0	10	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
R5941	001	0	1	31	11	R5941_001_0	10	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
R5941	002	0	1	31	11	R5941_002_0	10	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00		1	4
R5941	002	0	1	31	11	R5941_002_0	10	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
R5941	002	0	1	31	11	R5941_002_0	10	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
R5941	002	0	1	31	11	R5941_002_0	10	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
R5941	002	0	1	31	11	R5941_002_0	10	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
R5941	002	0	1	31	11	R5941_002_0	10	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
R5941	002	0	1	31	11	R5941_002_0	10	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
R5941	002	0	1	31	11	R5941_002_0	10	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			4
R5941	002	0	1	31	11	R5941_002_0	10	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00			4
R5941	002	0	1	31	11	R5941_002_0	10	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
R5941	003	0	1	31	11	R5941_003_0	10	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
R5941	003	0	1	31	11	R5941_003_0	10	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
R5941	003	0	1	31	11	R5941_003_0	10	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
R5941	003	0	1	31	11	R5941_003_0	10	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							12.00			24.00			4
R5941	003	0	1	31	11	R5941_003_0	10	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
R5941	004	0	1	31	11	R5941_004_0	9	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00		1	4
R5941	004	0	1	31	11	R5941_004_0	9	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
R5941	004	0	1	31	11	R5941_004_0	9	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
R5941	004	0	1	31	11	R5941_004_0	9	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
R5941	004	0	1	31	11	R5941_004_0	9	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
R5941	004	0	1	31	11	R5941_004_0	9	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
R5941	004	0	1	31	11	R5941_004_0	9	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
R5941	004	0	1	31	11	R5941_004_0	9	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			4
R5941	004	0	1	31	11	R5941_004_0	9	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	7.00	21.00								7.00							10.50			21.00			4
R5941	004	0	1	31	11	R5941_004_0	9	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
R6801	001	0	1	31	11	R6801_001_0	14	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	40.00	120.00								40.00				120.00									3
R6801	001	0	1	31	11	R6801_001_0	14	3	1	Formulary Non Preferred Brand	100000		2	Formulary Non Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non Preferred Brand	2	2		011000000010001000000	Formulary Non Preferred Brand																						Formulary Non Preferred Brand	80.00	240.00								80.00				240.00									3
R6801	001	0	1	31	11	R6801_001_0	14	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00				0.00									3
R6801	001	0	1	31	11	R6801_001_0	14	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
R6801	002	0	1	31	11	R6801_002_0	10	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									3
R6801	002	0	1	31	11	R6801_002_0	10	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00				75.00									3
R6801	002	0	1	31	11	R6801_002_0	10	3	1	Formulary Non Preferred Brand	100000		2	Formulary Non Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non Preferred Brand	2	2		011000000010001000000	Formulary Non Preferred Brand																						Formulary Non Preferred Brand	49.00	147.00								49.00				147.00									3
R6801	002	0	1	31	11	R6801_002_0	10	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
R6801	003	0	1	31	11	R6801_003_0	10	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00				75.00									3
R6801	003	0	1	31	11	R6801_003_0	10	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									3
R6801	003	0	1	31	11	R6801_003_0	10	3	1	Formulary Non Preferred Brand	100000		2	Formulary Non Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non Preferred Brand	2	2		011000000010001000000	Formulary Non Preferred Brand																						Formulary Non Preferred Brand	49.00	147.00								49.00				147.00									3
R6801	003	0	1	31	11	R6801_003_0	10	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
R6801	004	0	1	31	11	R6801_004_0	11	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
R6801	004	0	1	31	11	R6801_004_0	11	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00				75.00									4
R6801	004	0	1	31	11	R6801_004_0	11	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									4
R6801	004	0	1	31	11	R6801_004_0	11	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R6801	004	0	1	31	11	R6801_004_0	11	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R6801	004	0	1	31	11	R6801_004_0	11	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00								1	4
R6801	004	0	1	31	11	R6801_004_0	11	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R6801	004	0	1	31	11	R6801_004_0	11	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R6801	004	0	1	31	11	R6801_004_0	11	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R6801	004	0	1	31	11	R6801_004_0	11	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R6801	005	0	1	31	11	R6801_005_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									4
R6801	005	0	1	31	11	R6801_005_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								5.00				75.00									4
R6801	005	0	1	31	11	R6801_005_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
R6801	005	0	1	31	11	R6801_005_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R6801	005	0	1	31	11	R6801_005_0	10	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R6801	005	0	1	31	11	R6801_005_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R6801	005	0	1	31	11	R6801_005_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R6801	005	0	1	31	11	R6801_005_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R6801	005	0	1	31	11	R6801_005_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic																							Formulary Generic					Formulary Generic																						Formulary Generic																						2	4
R6801	005	0	1	31	11	R6801_005_0	10	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R6801	006	0	1	31	11	R6801_006_0	11	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
R6801	006	0	1	31	11	R6801_006_0	11	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00				75.00									4
R6801	006	0	1	31	11	R6801_006_0	11	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R6801	006	0	1	31	11	R6801_006_0	11	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R6801	006	0	1	31	11	R6801_006_0	11	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R6801	006	0	1	31	11	R6801_006_0	11	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R6801	006	0	1	31	11	R6801_006_0	11	1	3	Formulary Generic	010000	1	2	Formulary Generic																							Formulary Generic					Formulary Generic																						Formulary Generic																						2	4
R6801	006	0	1	31	11	R6801_006_0	11	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R6801	006	0	1	31	11	R6801_006_0	11	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R6801	006	0	1	31	11	R6801_006_0	11	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									4
R6801	007	0	1	31	11	R6801_007_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00									4
R6801	007	0	1	31	11	R6801_007_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R6801	007	0	1	31	11	R6801_007_0	10	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R6801	007	0	1	31	11	R6801_007_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	5.00	15.00								5.00				15.00								1	4
R6801	007	0	1	31	11	R6801_007_0	10	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R6801	007	0	1	31	11	R6801_007_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R6801	007	0	1	31	11	R6801_007_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R6801	007	0	1	31	11	R6801_007_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	49.00	147.00								49.00				147.00									4
R6801	007	0	1	31	11	R6801_007_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00				75.00									4
R6801	007	0	1	31	11	R6801_007_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R9896	001	0	1	31	11	R9896_001_0	9	3	1	Formulary Non Preferred Brand	100000		2	Formulary Non Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non Preferred Brand	2	2		011000000010001000000	Formulary Non Preferred Brand																						Formulary Non Preferred Brand	60.00	180.00								60.00				180.00									3
R9896	001	0	1	31	11	R9896_001_0	9	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00				0.00									3
R9896	001	0	1	31	11	R9896_001_0	9	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	40.00	120.00								40.00				120.00									3
R9896	001	0	1	31	11	R9896_001_0	9	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
R9896	002	0	1	31	11	R9896_002_0	9	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	4.00	12.00								4.00				12.00									3
R9896	002	0	1	31	11	R9896_002_0	9	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	22.00	66.00								22.00				66.00									3
R9896	002	0	1	31	11	R9896_002_0	9	3	1	Formulary Non Preferred Brand	100000		2	Formulary Non Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non Preferred Brand	2	2		011000000010001000000	Formulary Non Preferred Brand																						Formulary Non Preferred Brand	47.00	141.00								47.00				141.00									3
R9896	002	0	1	31	11	R9896_002_0	9	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
R9896	003	0	1	31	11	R9896_003_0	10	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	4.00	12.00								4.00				12.00									3
R9896	003	0	1	31	11	R9896_003_0	10	4	1	Formulary Specialty	010010		1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							3
R9896	003	0	1	31	11	R9896_003_0	10	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	22.00	66.00								22.00				66.00									3
R9896	003	0	1	31	11	R9896_003_0	10	3	1	Formulary Non Preferred Brand	100000		2	Formulary Non Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non Preferred Brand	2	2		011000000010001000000	Formulary Non Preferred Brand																						Formulary Non Preferred Brand	47.00	141.00								47.00				141.00									3
R9896	004	0	1	31	11	R9896_004_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R9896	004	0	1	31	11	R9896_004_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R9896	004	0	1	31	11	R9896_004_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	4.00	12.00								4.00				12.00								1	4
R9896	004	0	1	31	11	R9896_004_0	10	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R9896	004	0	1	31	11	R9896_004_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R9896	004	0	1	31	11	R9896_004_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	47.00	141.00								47.00				141.00									4
R9896	004	0	1	31	11	R9896_004_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	22.00	66.00								22.00				66.00									4
R9896	004	0	1	31	11	R9896_004_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	4.00	12.00								4.00				12.00									4
R9896	004	0	1	31	11	R9896_004_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R9896	004	0	1	31	11	R9896_004_0	10	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R9896	005	0	1	31	11	R9896_005_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	4.00	12.00								4.00				12.00									4
R9896	005	0	1	31	11	R9896_005_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	22.00	66.00								22.00				66.00									4
R9896	005	0	1	31	11	R9896_005_0	10	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R9896	005	0	1	31	11	R9896_005_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R9896	005	0	1	31	11	R9896_005_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R9896	005	0	1	31	11	R9896_005_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R9896	005	0	1	31	11	R9896_005_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic																							Formulary Generic					Formulary Generic																						Formulary Generic																						2	4
R9896	005	0	1	31	11	R9896_005_0	10	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R9896	005	0	1	31	11	R9896_005_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R9896	005	0	1	31	11	R9896_005_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	47.00	141.00								47.00				141.00									4
R9896	006	0	1	31	11	R9896_006_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	4.00	12.00								4.00				12.00									4
R9896	006	0	1	31	11	R9896_006_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R9896	006	0	1	31	11	R9896_006_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R9896	006	0	1	31	11	R9896_006_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R9896	006	0	1	31	11	R9896_006_0	10	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R9896	006	0	1	31	11	R9896_006_0	10	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R9896	006	0	1	31	11	R9896_006_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R9896	006	0	1	31	11	R9896_006_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	47.00	141.00								47.00				141.00									4
R9896	006	0	1	31	11	R9896_006_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	22.00	66.00								22.00				66.00									4
R9896	006	0	1	31	11	R9896_006_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic																							Formulary Generic					Formulary Generic																						Formulary Generic																						2	4
R9896	007	0	1	31	11	R9896_007_0	10	3	1	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand	011000000010001000000	30	90								30				90								Formulary Non-Preferred Brand	2	2		011000000010001000000	Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand	47.00	141.00								47.00				141.00									4
R9896	007	0	1	31	11	R9896_007_0	10	4	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000010001000000	30	90								30				90								Formulary Specialty	2	1	011000000010001000000		Formulary Specialty	33	33								33				33								Formulary Specialty																							4
R9896	007	0	1	31	11	R9896_007_0	10	5	1	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00									4
R9896	007	0	1	31	11	R9896_007_0	10	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	4.00	12.00								4.00				12.00								1	4
R9896	007	0	1	31	11	R9896_007_0	10	2	3	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand																							Formulary Preferred Brand					Formulary Preferred Brand																						Formulary Preferred Brand																						2	4
R9896	007	0	1	31	11	R9896_007_0	10	3	3	Formulary Non-Preferred Brand	100000	1	2	Formulary Non-Preferred Brand																							Formulary Non-Preferred Brand					Formulary Non-Preferred Brand																						Formulary Non-Preferred Brand																						2	4
R9896	007	0	1	31	11	R9896_007_0	10	4	3	Formulary Specialty	010010	1	1	Formulary Specialty																							Formulary Specialty					Formulary Specialty																						Formulary Specialty																						2	4
R9896	007	0	1	31	11	R9896_007_0	10	5	3	Formulary Zero Copay	010010	1	2	Formulary Zero Copay	011000000010001000000	30	90								30				90								Formulary Zero Copay	2	2		011000000010001000000	Formulary Zero Copay																						Formulary Zero Copay	0.00	0.00								0.00				0.00								1	4
R9896	007	0	1	31	11	R9896_007_0	10	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010001000000	30	90								30				90								Formulary Generic	2	2		011000000010001000000	Formulary Generic																						Formulary Generic	4.00	12.00								4.00				12.00									4
R9896	007	0	1	31	11	R9896_007_0	10	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000010001000000	30	90								30				90								Formulary Preferred Brand	2	2		011000000010001000000	Formulary Preferred Brand																						Formulary Preferred Brand	22.00	66.00								22.00				66.00									4
R9943	001	0	1	31	11	R9943_001_0	8	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
R9943	001	0	1	31	11	R9943_001_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
R9943	001	0	1	31	11	R9943_001_0	8	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
R9943	001	0	1	31	11	R9943_001_0	8	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
R9943	001	0	1	31	11	R9943_001_0	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
R9943	001	0	1	31	11	R9943_001_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
R9943	001	0	1	31	11	R9943_001_0	8	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
R9943	001	0	1	31	11	R9943_001_0	8	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
R9943	001	0	1	31	11	R9943_001_0	8	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
R9943	001	0	1	31	11	R9943_001_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
R9943	002	0	1	31	11	R9943_002_0	8	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
R9943	002	0	1	31	11	R9943_002_0	8	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
R9943	002	0	1	31	11	R9943_002_0	8	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
R9943	002	0	1	31	11	R9943_002_0	8	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
R9943	002	0	1	31	11	R9943_002_0	8	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
R9943	002	0	1	31	11	R9943_002_0	8	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
R9943	002	0	1	31	11	R9943_002_0	8	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
R9943	002	0	1	31	11	R9943_002_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
R9943	002	0	1	31	11	R9943_002_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
R9943	002	0	1	31	11	R9943_002_0	8	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S0043	009	0		29	10	S0043_009_0	3	3	1	Formulary Brand	000010		2	Formulary Brand	011000000011000000000	30	90								30	90											Formulary Brand	2	2		011000000011000000000	Formulary Brand																						Formulary Brand	55.00	165.00								55.00	165.00												3
S0043	009	0		29	10	S0043_009_0	3	2	1	Formulary Preferred Brand	000001		2	Formulary Preferred Brand	011000000011000000000	30	90								30	90											Formulary Preferred Brand	2	2		011000000011000000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00	75.00												3
S0043	009	0		29	10	S0043_009_0	3	1	1	Formulary Generic	010000		2	Formulary Generic	011000000011000000000	30	90								30	90											Formulary Generic	2	2		011000000011000000000	Formulary Generic																						Formulary Generic	10.00	30.00								10.00	30.00												3
S0043	009	0		29	10	S0043_009_0	3	4	1	Preferred Brand	000001		1	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000011000000000	Preferred Brand																						Preferred Brand	55.00	165.00								55.00	165.00												3
S0043	010	0		29	10	S0043_010_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000011000000000	30	90								30	90											Formulary Generic	2	2		011000000011000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00	0.00												4
S0043	010	0		29	10	S0043_010_0	3	2	1	Formulary Preferred Brand	000001	1	2	Formulary Preferred Brand	011000000011000000000	30	90								30	90											Formulary Preferred Brand	2	2		011000000011000000000	Formulary Preferred Brand																						Formulary Preferred Brand	25.00	75.00								25.00	75.00												4
S0043	010	0		29	10	S0043_010_0	3	3	1	Formulary Brand	000010	1	2	Formulary Brand	011000000011000000000	30	90								30	90											Formulary Brand	2	2		011000000011000000000	Formulary Brand																						Formulary Brand	55.00	165.00								55.00	165.00												4
S0043	010	0		29	10	S0043_010_0	3	4	1	Preferred Brand	000001	1	1	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000011000000000	Preferred Brand																						Preferred Brand	55.00	165.00								55.00	165.00												4
S0197	002	0		29	10	S0197_002_0	5	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00				136.00									4
S0197	002	0		29	10	S0197_002_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S0197	002	0		29	10	S0197_002_0	5	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00				20.00									4
S0197	002	0		29	10	S0197_002_0	5	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S0197	003	0		29	10	S0197_003_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	61.00	183.00								61.00				122.00									3
S0197	003	0		29	10	S0197_003_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S0197	003	0		29	10	S0197_003_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S0197	003	0		29	10	S0197_003_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S0197	005	0		29	10	S0197_005_0	5	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S0197	005	0		29	10	S0197_005_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S0197	005	0		29	10	S0197_005_0	5	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S0197	005	0		29	10	S0197_005_0	5	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S0197	005	0		29	10	S0197_005_0	5	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00				140.00									4
S0197	005	0		29	10	S0197_005_0	5	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S0197	005	0		29	10	S0197_005_0	5	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S0197	005	0		29	10	S0197_005_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S1030	001	0		29	10	S1030_001_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	75.00									3
S1030	001	0		29	10	S1030_001_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	2	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							3
S1030	001	0		29	10	S1030_001_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	137.50									3
S1030	001	0		29	10	S1030_001_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	12.50									3
S1030	003	0		29	10	S1030_003_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	12.50									4
S1030	003	0		29	10	S1030_003_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	2	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							4
S1030	003	0		29	10	S1030_003_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00		30.00	75.00									4
S1030	003	0		29	10	S1030_003_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	2		011000000011011000000	Tier 3																						Tier 3	55.00	165.00								55.00	165.00		55.00	137.50									4
S1030	003	0		29	10	S1030_003_0	3	1	3	Tier 1	010000	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	5.00	15.00								5.00	15.00		5.00	12.50								1	4
S1030	003	0		29	10	S1030_003_0	3	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S1030	003	0		29	10	S1030_003_0	3	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S1030	003	0		29	10	S1030_003_0	3	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S1030	004	0		29	10	S1030_004_0	3	3	1	Tier 3	100000	1	2	Tier 3	011000000011011000000	30	90								30	90		30	90								Tier 3	2	1	011000000011011000000		Tier 3	25	25								25	25		25	25								Tier 3																							4
S1030	004	0		29	10	S1030_004_0	3	4	1	Tier 4	000010	1	1	Tier 4	011000000011011000000	30	90								30	90		30	90								Tier 4	2	1	011000000011011000000		Tier 4	25	25								25	25		25	25								Tier 4																							4
S1030	004	0		29	10	S1030_004_0	3	2	1	Tier 2	000001	1	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	1	011000000011011000000		Tier 2	25	25								25	25		25	25								Tier 2																							4
S1030	004	0		29	10	S1030_004_0	3	1	1	Tier 1	010000	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	1	011000000011011000000		Tier 1	25	25								25	25		25	25								Tier 1																							4
S1566	002	0		29	10	S1566_002_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S1566	002	0		29	10	S1566_002_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									3
S1566	002	0		29	10	S1566_002_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	60.00	180.00								60.00	180.00		60.00	120.00									3
S1566	002	0		29	10	S1566_002_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S2321	002	0		29	10	S2321_002_0	2	1	1	Tier 1 - Generic	010000	1	2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	15.00								5.00	15.00		5.00	10.00									4
S2321	002	0		29	10	S2321_002_0	2	2	1	Tier 2 - Preferred Brand	000001	1	2	Tier 2 - Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 2 - Preferred Brand	2	2		011000000011011000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									4
S2321	002	0		29	10	S2321_002_0	2	3	1	Tier 3 - Non-Preferred Brand	100000	1	2	Tier 3 - Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 3 - Non-Preferred Brand	2	2		011000000011011000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	150.00								50.00	150.00		50.00	100.00									4
S2321	002	0		29	10	S2321_002_0	2	1	3	Tier 1 - Generic	010000	1	2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	15.00								5.00	15.00		5.00	10.00								1	4
S2321	002	0		29	10	S2321_002_0	2	2	3	Tier 2 - Preferred Brand	000001	1	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
S2321	002	0		29	10	S2321_002_0	2	3	3	Tier 3 - Non-Preferred Brand	100000	1	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
S2468	001	0		29	10	S2468_001_0	4	1	1	Formulary Generic	011000	3	2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				10.00	20.00		10.00	30.00		10.00				20.00									4
S2468	001	0		29	10	S2468_001_0	4	2	1	Formulary Brand	000001	3	2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				25.00	50.00		25.00	75.00		25.00				50.00									4
S2468	001	0		29	10	S2468_001_0	4	3	1	Non-Preferred Brand	100000	3	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	100.00		50.00	150.00		50.00				100.00									4
S2468	001	0		29	10	S2468_001_0	4	4	1	Injectables	001001	3	2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																							4
S2468	001	0		29	10	S2468_001_0	4	5	1	Formulary Specialty (Unique High Cost Drugs)	001001	3	1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																							4
S2468	002	0		29	10	S2468_002_0	5	4	1	Injectables	001001		2	Injectables	000011011010001000000				30	90		30	90		30				90								Injectables	2	1	000011011010001000000		Injectables				20	20		20	20		20				20								Injectables																							3
S2468	002	0		29	10	S2468_002_0	5	5	1	Formulary Specialty (Unique High Cost Drugs)	001001		1	Formulary Specialty (Unique High Cost Drugs)	000011011010001000000				30	90		30	90		30				90								Formulary Specialty (Unique High Cost Drugs)	2	1	000011011010001000000		Formulary Specialty (Unique High Cost Drugs)				25	25		25	25		25				25								Formulary Specialty (Unique High Cost Drugs)																							3
S2468	002	0		29	10	S2468_002_0	5	1	1	Formulary Generic	011000		2	Formulary Generic	000011011010001000000				30	90		30	90		30				90								Formulary Generic	2	2		000011011010001000000	Formulary Generic																						Formulary Generic				4.00	8.00		4.00	12.00		4.00				8.00									3
S2468	002	0		29	10	S2468_002_0	5	2	1	Formulary Brand	000001		2	Formulary Brand	000011011010001000000				30	90		30	90		30				90								Formulary Brand	2	2		000011011010001000000	Formulary Brand																						Formulary Brand				25.00	50.00		25.00	75.00		25.00				50.00									3
S2468	002	0		29	10	S2468_002_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				60.00	120.00		60.00	180.00		60.00				120.00									3
S2505	001	0		29	10	S2505_001_0	1	1	1	Tier 1	010000		2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	10.00	30.00	10.00							10.00	30.00	10.00	10.00	30.00	10.00								3
S2505	001	0		29	10	S2505_001_0	1	4	1	Tier 4	000010		1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							3
S2505	001	0		29	10	S2505_001_0	1	2	1	Tier 2	000001		2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								3
S2505	001	0		29	10	S2505_001_0	1	3	1	Tier 3	100000		2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	60.00	180.00	60.00							60.00	180.00	60.00	60.00	180.00	60.00								3
S2505	002	0		29	10	S2505_002_0	2	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S2505	002	0		29	10	S2505_002_0	2	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S2505	002	0		29	10	S2505_002_0	2	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S2505	002	0		29	10	S2505_002_0	2	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00							1	4
S2505	002	0		29	10	S2505_002_0	2	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
S2505	002	0		29	10	S2505_002_0	2	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
S2505	002	0		29	10	S2505_002_0	2	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
S2505	002	0		29	10	S2505_002_0	2	3	1	Tier 3	100000	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
S2505	003	0		29	10	S2505_003_0	1	4	1	Tier 4	000010		1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							3
S2505	003	0		29	10	S2505_003_0	1	3	1	Tier 3	100000		2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	60.00	180.00	60.00							60.00	180.00	60.00	60.00	180.00	60.00								3
S2505	003	0		29	10	S2505_003_0	1	1	1	Tier 1	010000		2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	10.00	30.00	10.00							10.00	30.00	10.00	10.00	30.00	10.00								3
S2505	003	0		29	10	S2505_003_0	1	2	1	Tier 2	000001		2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								3
S2505	004	0		29	10	S2505_004_0	2	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
S2505	004	0		29	10	S2505_004_0	2	3	1	Tier 3	100000	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
S2505	004	0		29	10	S2505_004_0	2	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
S2505	004	0		29	10	S2505_004_0	2	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00							1	4
S2505	004	0		29	10	S2505_004_0	2	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S2505	004	0		29	10	S2505_004_0	2	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
S2505	004	0		29	10	S2505_004_0	2	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S2505	004	0		29	10	S2505_004_0	2	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S2505	005	0		29	10	S2505_005_0	1	2	1	Tier 2	000001		2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								3
S2505	005	0		29	10	S2505_005_0	1	4	1	Tier 4	000010		1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							3
S2505	005	0		29	10	S2505_005_0	1	3	1	Tier 3	100000		2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	60.00	180.00	60.00							60.00	180.00	60.00	60.00	180.00	60.00								3
S2505	005	0		29	10	S2505_005_0	1	1	1	Tier 1	010000		2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	10.00	30.00	10.00							10.00	30.00	10.00	10.00	30.00	10.00								3
S2505	006	0		29	10	S2505_006_0	2	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S2505	006	0		29	10	S2505_006_0	2	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S2505	006	0		29	10	S2505_006_0	2	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S2505	006	0		29	10	S2505_006_0	2	1	3	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00							1	4
S2505	006	0		29	10	S2505_006_0	2	4	1	Tier 4	000010	1	1	Tier 4	011100000011100000000	30	90	15							30	90	15										Tier 4	2	1	011100000011100000000		Tier 4	33	33	33							33	33	33										Tier 4																							4
S2505	006	0		29	10	S2505_006_0	2	3	1	Tier 3	100000	1	2	Tier 3	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 3	2	2		011100000011111100000	Tier 3																						Tier 3	50.00	150.00	50.00							50.00	150.00	50.00	50.00	150.00	50.00								4
S2505	006	0		29	10	S2505_006_0	2	2	1	Tier 2	000001	1	2	Tier 2	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 2	2	2		011100000011111100000	Tier 2																						Tier 2	35.00	105.00	35.00							35.00	105.00	35.00	35.00	105.00	35.00								4
S2505	006	0		29	10	S2505_006_0	2	1	1	Tier 1	010000	1	2	Tier 1	011100000011111100000	30	90	15							30	90	15	30	90	15							Tier 1	2	2		011100000011111100000	Tier 1																						Tier 1	5.00	15.00	5.00							5.00	15.00	5.00	5.00	15.00	5.00								4
S2874	002	0		29	10	S2874_002_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00			25.00	62.50									4
S2874	002	0		29	10	S2874_002_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S2874	002	0		29	10	S2874_002_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S2874	002	0		29	10	S2874_002_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	50.00	150.00								50.00			50.00	125.00									4
S2893	001	0		29	10	S2893_001_0	8	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			30		Specialty Injectables																							4
S2893	001	0		29	10	S2893_001_0	8	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S2893	001	0		29	10	S2893_001_0	8	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			30		Non-Specialty Injectables																							4
S2893	001	0		29	10	S2893_001_0	8	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							20.00			24.00			4
S2893	001	0		29	10	S2893_001_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			4
S2893	003	0		29	10	S2893_003_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							20.00			24.00			4
S2893	003	0		29	10	S2893_003_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	24.00	72.00								24.00							60.00			72.00			4
S2893	003	0		29	10	S2893_003_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00							135.00			162.00			4
S2893	003	0		29	10	S2893_003_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			30		Non-Specialty Injectables																							4
S2893	003	0		29	10	S2893_003_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			30		Specialty Injectables																							4
S2893	003	0		29	10	S2893_003_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S2893	003	0		29	10	S2893_003_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							20.00			24.00		1	4
S2893	003	0		29	10	S2893_003_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S2893	003	0		29	10	S2893_003_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S2893	003	0		29	10	S2893_003_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S2893	014	0		29	10	S2893_014_0	8	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							20.00			24.00			2
S2893	014	0		29	10	S2893_014_0	8	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								30							25			25		Non-Specialty Injectables																							2
S2893	014	0		29	10	S2893_014_0	8	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00							135.00			162.00			2
S2893	014	0		29	10	S2893_014_0	8	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	25.00	75.00								25.00							62.50			75.00			2
S2893	014	0		29	10	S2893_014_0	8	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								30							25			25		Specialty Injectables																							2
S3230	001	0		29	10	S3230_001_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			80.00									3
S3230	001	0		29	10	S3230_001_0	1	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00									3
S3230	001	0		29	10	S3230_001_0	1	4	1	Specialty	110001		1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							3
S3230	001	0		29	10	S3230_001_0	1	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	75	75								75	75			75								Non-Preferred Brand																							3
S3230	002	0		29	10	S3230_002_0	1	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00								1	4
S3230	002	0		29	10	S3230_002_0	1	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			10.00									4
S3230	002	0		29	10	S3230_002_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	2	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			80.00									4
S3230	002	0		29	10	S3230_002_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	2	1	011000000011001000000		Non-Preferred Brand	75	75								75	75			75								Non-Preferred Brand																							4
S3230	002	0		29	10	S3230_002_0	1	4	1	Specialty	110001	1	1	Specialty	011000000011001000000	30	90								30	90			90								Specialty	2	1	011000000011001000000		Specialty	33	33								33	33			33								Specialty																							4
S3230	002	0		29	10	S3230_002_0	1	4	3	Specialty	110001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S3230	002	0		29	10	S3230_002_0	1	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S3230	002	0		29	10	S3230_002_0	1	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S3389	005	0		29	10	S3389_005_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00				96.00									3
S3389	005	0		29	10	S3389_005_0	2	4	1	Low Cost Injectables	010010		2	Low Cost Injectables	011000000010001000000	31	90								31				90								Low Cost Injectables	2	1	011000000010001000000		Low Cost Injectables	25	25								25				25								Low Cost Injectables																							3
S3389	005	0		29	10	S3389_005_0	2	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	64.00	192.00								64.00				192.00									3
S3389	005	0		29	10	S3389_005_0	2	5	1	Specialty	010010		1	Specialty	010000000010010000000	31									31			31									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
S3389	005	0		29	10	S3389_005_0	2	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									3
S3389	006	0		29	10	S3389_006_0	2	4	3	Low Cost Injectables	010010	1	2	Low Cost Injectables																							Low Cost Injectables					Low Cost Injectables																						Low Cost Injectables																						2	4
S3389	006	0		29	10	S3389_006_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S3389	006	0		29	10	S3389_006_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S3389	006	0		29	10	S3389_006_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S3389	006	0		29	10	S3389_006_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00								1	4
S3389	006	0		29	10	S3389_006_0	2	5	1	Specialty	010010	1	1	Specialty	010000000010010000000	31									31			31									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S3389	006	0		29	10	S3389_006_0	2	4	1	Low Cost Injectables	010010	1	2	Low Cost Injectables	011000000010001000000	31	90								31				90								Low Cost Injectables	2	1	011000000010001000000		Low Cost Injectables	25	25								25				25								Low Cost Injectables																							4
S3389	006	0		29	10	S3389_006_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00				150.00									4
S3389	006	0		29	10	S3389_006_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									4
S3389	006	0		29	10	S3389_006_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									4
S3521	001	0		29	10	S3521_001_0	2	2	1	Brand	000010		2	Brand	011000000010001000000	30	90								30				90								Brand	2	1	011000000010001000000		Brand	25	20								25				20								Brand																							2
S3521	001	0		29	10	S3521_001_0	2	1	1	Generic	010000		2	Generic	011000000010001000000	30	90								30				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	12.50								5.00				12.50									2
S3521	002	0		29	10	S3521_002_0	3	1	1	Generic Drugs	010000	1	2	Generic Drugs	011000000010001000000	30	90								30				90								Generic Drugs	2	2		011000000010001000000	Generic Drugs																						Generic Drugs	5.00	12.50								5.00				12.50									4
S3521	002	0		29	10	S3521_002_0	3	2	3	Brand Drugs	000010	1	2	Brand Drugs																							Brand Drugs					Brand Drugs																						Brand Drugs																						2	4
S3521	002	0		29	10	S3521_002_0	3	1	3	Generic Drugs	010000	1	2	Generic Drugs	011000000010001000000	30	90								30				90								Generic Drugs	2	2		011000000010001000000	Generic Drugs																						Generic Drugs	5.00	12.50								5.00				12.50								1	4
S3521	002	0		29	10	S3521_002_0	3	2	1	Brand Drugs	000010	1	2	Brand Drugs	011000000010001000000	30	90								30				90								Brand Drugs	2	1	011000000010001000000		Brand Drugs	30	25								30				25								Brand Drugs																							4
S3521	003	0		29	10	S3521_003_0	4	3	1	Specialty Drugs	000010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	33	28								33				28								Specialty Drugs																							4
S3521	003	0		29	10	S3521_003_0	4	1	1	Generic Drugs	010000	1	2	Generic Drugs	011000000010001000000	30	90								30				90								Generic Drugs	2	2		011000000010001000000	Generic Drugs																						Generic Drugs	0.00	0.00								0.00				0.00									4
S3521	003	0		29	10	S3521_003_0	4	2	1	Brand Drug	000010	1	2	Brand Drug	011000000010001000000	30	90								30				90								Brand Drug	2	2		011000000010001000000	Brand Drug																						Brand Drug	35.00	87.50								35.00				87.50									4
S3994	001	0		29	10	S3994_001_0	5	4	1	Tier 4 - Injectables	010010		2	Tier 4 - Injectables	011000000011000000000	30	90								30	90											Tier 4 - Injectables	2	1	011000000011000000000		Tier 4 - Injectables	25	25								25	25											Tier 4 - Injectables																							2
S3994	001	0		29	10	S3994_001_0	5	3	1	Tier 3 - Other Brand	100000		2	Tier 3 - Other Brand	011000000011001000000	30	90								30	90			90								Tier 3 - Other Brand	2	2		011000000011001000000	Tier 3 - Other Brand																						Tier 3 - Other Brand	50.00	150.00								50.00	150.00			120.00									2
S3994	001	0		29	10	S3994_001_0	5	5	1	Tier 5 - Specialty	010010		1	Tier 5 - Specialty	011000000011000000000	30	90								30	90											Tier 5 - Specialty	2	1	011000000011000000000		Tier 5 - Specialty	25	25								25	25											Tier 5 - Specialty																							2
S3994	001	0		29	10	S3994_001_0	5	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	011000000011001000000	30	90								30	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	3.00	9.00								3.00	9.00			5.00									2
S3994	001	0		29	10	S3994_001_0	5	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	011000000011001000000	30	90								30	90			90								Tier 2 - Preferred Brand	2	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	20.00	60.00								20.00	60.00			50.00									2
S4248	002	0		29	10	S4248_002_0	5	1	1	Tier 1 (generic drugs)	011100		2	Tier 1 (generic drugs)	011000000010001000000	34	90								34				90								Tier 1 (generic drugs)	2	2		011000000010001000000	Tier 1 (generic drugs)																						Tier 1 (generic drugs)	5.00	15.00								5.00				12.50									3
S4248	002	0		29	10	S4248_002_0	5	3	1	Tier 3 (non-preferred brand-name drugs)	100000		2	Tier 3 (non-preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 3 (non-preferred brand-name drugs)	2	2		011000000010001000000	Tier 3 (non-preferred brand-name drugs)																						Tier 3 (non-preferred brand-name drugs)	78.00	234.00								78.00				195.00									3
S4248	002	0		29	10	S4248_002_0	5	2	1	Tier 2 (preferred brand-name drugs)	000011		2	Tier 2 (preferred brand-name drugs)	011000000010001000000	34	90								34				90								Tier 2 (preferred brand-name drugs)	2	2		011000000010001000000	Tier 2 (preferred brand-name drugs)																						Tier 2 (preferred brand-name drugs)	36.00	108.00								36.00				90.00									3
S4496	002	0		29	10	S4496_002_0	2	1	1	Tier 1 - Generic	010000	1	2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	15.00								5.00	15.00		5.00	10.00									4
S4496	002	0		29	10	S4496_002_0	2	2	1	Tier 2 - Preferred Brand	000001	1	2	Tier 2 - Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 2 - Preferred Brand	2	2		011000000011011000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									4
S4496	002	0		29	10	S4496_002_0	2	3	3	Tier 3 - Non-Preferred Brand	100000	1	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
S4496	002	0		29	10	S4496_002_0	2	1	3	Tier 1 - Generic	010000	1	2	Tier 1 - Generic	011000000011011000000	30	90								30	90		30	90								Tier 1 - Generic	2	2		011000000011011000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	15.00								5.00	15.00		5.00	10.00								1	4
S4496	002	0		29	10	S4496_002_0	2	2	3	Tier 2 - Preferred Brand	000001	1	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
S4496	002	0		29	10	S4496_002_0	2	3	1	Tier 3 - Non-Preferred Brand	100000	1	2	Tier 3 - Non-Preferred Brand	011000000011011000000	30	90								30	90		30	90								Tier 3 - Non-Preferred Brand	2	2		011000000011011000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	150.00								50.00	150.00		50.00	100.00									4
S4802	001	0		29	10	S4802_001_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	138.00										46.00		92.00									3
S4802	001	0		29	10	S4802_001_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	90.00										30.00		60.00									3
S4802	001	0		29	10	S4802_001_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	001	0		29	10	S4802_001_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	002	0		29	10	S4802_002_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	002	0		29	10	S4802_002_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	002	0		29	10	S4802_002_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	002	0		29	10	S4802_002_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	003	0		29	10	S4802_003_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	003	0		29	10	S4802_003_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	003	0		29	10	S4802_003_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	138.00										46.00		92.00									3
S4802	003	0		29	10	S4802_003_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	004	0		29	10	S4802_004_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	004	0		29	10	S4802_004_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	004	0		29	10	S4802_004_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	004	0		29	10	S4802_004_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	005	0		29	10	S4802_005_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	005	0		29	10	S4802_005_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	33.00	99.00										33.00		66.00									3
S4802	005	0		29	10	S4802_005_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	005	0		29	10	S4802_005_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	006	0		29	10	S4802_006_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	006	0		29	10	S4802_006_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	006	0		29	10	S4802_006_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	006	0		29	10	S4802_006_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	007	0		29	10	S4802_007_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	007	0		29	10	S4802_007_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	007	0		29	10	S4802_007_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	007	0		29	10	S4802_007_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	008	0		29	10	S4802_008_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	008	0		29	10	S4802_008_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	008	0		29	10	S4802_008_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	008	0		29	10	S4802_008_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	009	0		29	10	S4802_009_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	009	0		29	10	S4802_009_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	009	0		29	10	S4802_009_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	009	0		29	10	S4802_009_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	010	0		29	10	S4802_010_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	010	0		29	10	S4802_010_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	010	0		29	10	S4802_010_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	010	0		29	10	S4802_010_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	011	0		29	10	S4802_011_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	011	0		29	10	S4802_011_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	33.00	99.00										33.00		66.00									3
S4802	011	0		29	10	S4802_011_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	011	0		29	10	S4802_011_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	012	0		29	10	S4802_012_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	012	0		29	10	S4802_012_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	012	0		29	10	S4802_012_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	012	0		29	10	S4802_012_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	013	0		29	10	S4802_013_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	013	0		29	10	S4802_013_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	013	0		29	10	S4802_013_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	138.00										46.00		92.00									3
S4802	013	0		29	10	S4802_013_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	014	0		29	10	S4802_014_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	014	0		29	10	S4802_014_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	014	0		29	10	S4802_014_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	014	0		29	10	S4802_014_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	015	0		29	10	S4802_015_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	015	0		29	10	S4802_015_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	90.00										30.00		60.00									3
S4802	015	0		29	10	S4802_015_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	138.00										46.00		92.00									3
S4802	015	0		29	10	S4802_015_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	016	0		29	10	S4802_016_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	016	0		29	10	S4802_016_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	33.00	99.00										33.00		66.00									3
S4802	016	0		29	10	S4802_016_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	138.00										46.00		92.00									3
S4802	016	0		29	10	S4802_016_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	017	0		29	10	S4802_017_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	017	0		29	10	S4802_017_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	017	0		29	10	S4802_017_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	017	0		29	10	S4802_017_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	018	0		29	10	S4802_018_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	018	0		29	10	S4802_018_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	018	0		29	10	S4802_018_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	018	0		29	10	S4802_018_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	019	0		29	10	S4802_019_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	019	0		29	10	S4802_019_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	019	0		29	10	S4802_019_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	33.00	99.00										33.00		66.00									3
S4802	019	0		29	10	S4802_019_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	020	0		29	10	S4802_020_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	020	0		29	10	S4802_020_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	020	0		29	10	S4802_020_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	020	0		29	10	S4802_020_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	021	0		29	10	S4802_021_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	021	0		29	10	S4802_021_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	021	0		29	10	S4802_021_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	021	0		29	10	S4802_021_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	022	0		29	10	S4802_022_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	138.00										46.00		92.00									3
S4802	022	0		29	10	S4802_022_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	022	0		29	10	S4802_022_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	022	0		29	10	S4802_022_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	023	0		29	10	S4802_023_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	023	0		29	10	S4802_023_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	023	0		29	10	S4802_023_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	023	0		29	10	S4802_023_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	024	0		29	10	S4802_024_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	024	0		29	10	S4802_024_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	024	0		29	10	S4802_024_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	33.00	99.00										33.00		66.00									3
S4802	024	0		29	10	S4802_024_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	025	0		29	10	S4802_025_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	025	0		29	10	S4802_025_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	138.00										46.00		92.00									3
S4802	025	0		29	10	S4802_025_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	025	0		29	10	S4802_025_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	026	0		29	10	S4802_026_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	46.00	138.00										46.00		92.00									3
S4802	026	0		29	10	S4802_026_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	026	0		29	10	S4802_026_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	026	0		29	10	S4802_026_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	027	0		29	10	S4802_027_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	027	0		29	10	S4802_027_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	027	0		29	10	S4802_027_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	027	0		29	10	S4802_027_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	028	0		29	10	S4802_028_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	028	0		29	10	S4802_028_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	028	0		29	10	S4802_028_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	028	0		29	10	S4802_028_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	029	0		29	10	S4802_029_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	029	0		29	10	S4802_029_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	029	0		29	10	S4802_029_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	029	0		29	10	S4802_029_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	33.00	99.00										33.00		66.00									3
S4802	030	0		29	10	S4802_030_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	030	0		29	10	S4802_030_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	030	0		29	10	S4802_030_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	030	0		29	10	S4802_030_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	31.00	93.00										31.00		62.00									3
S4802	031	0		29	10	S4802_031_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	031	0		29	10	S4802_031_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	031	0		29	10	S4802_031_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	031	0		29	10	S4802_031_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	032	0		29	10	S4802_032_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	45.00	135.00										45.00		90.00									3
S4802	032	0		29	10	S4802_032_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	032	0		29	10	S4802_032_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	032	0		29	10	S4802_032_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	34.00	102.00										34.00		68.00									3
S4802	033	0		29	10	S4802_033_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000000101000000	30	90										10		90								Non-Preferred Brand	1	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00										44.00		88.00									3
S4802	033	0		29	10	S4802_033_0	4	4	1	Specialty	000010		1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							3
S4802	033	0		29	10	S4802_033_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	32.00	96.00										32.00		64.00									3
S4802	033	0		29	10	S4802_033_0	4	1	1	Generic	010000		2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	10.00	30.00										10.00		20.00									3
S4802	034	0		29	10	S4802_034_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	034	0		29	10	S4802_034_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	034	0		29	10	S4802_034_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	034	0		29	10	S4802_034_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	034	0		29	10	S4802_034_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	034	0		29	10	S4802_034_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	034	0		29	10	S4802_034_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	034	0		29	10	S4802_034_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	035	0		29	10	S4802_035_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	035	0		29	10	S4802_035_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	035	0		29	10	S4802_035_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	035	0		29	10	S4802_035_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	035	0		29	10	S4802_035_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	035	0		29	10	S4802_035_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	035	0		29	10	S4802_035_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	035	0		29	10	S4802_035_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	036	0		29	10	S4802_036_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	036	0		29	10	S4802_036_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	036	0		29	10	S4802_036_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	036	0		29	10	S4802_036_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	036	0		29	10	S4802_036_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	036	0		29	10	S4802_036_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	036	0		29	10	S4802_036_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	036	0		29	10	S4802_036_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	037	0		29	10	S4802_037_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	037	0		29	10	S4802_037_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	037	0		29	10	S4802_037_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	037	0		29	10	S4802_037_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	037	0		29	10	S4802_037_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	037	0		29	10	S4802_037_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	037	0		29	10	S4802_037_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	037	0		29	10	S4802_037_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	038	0		29	10	S4802_038_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	038	0		29	10	S4802_038_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	038	0		29	10	S4802_038_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	038	0		29	10	S4802_038_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	038	0		29	10	S4802_038_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	038	0		29	10	S4802_038_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	038	0		29	10	S4802_038_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	038	0		29	10	S4802_038_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	039	0		29	10	S4802_039_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	039	0		29	10	S4802_039_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	039	0		29	10	S4802_039_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	039	0		29	10	S4802_039_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	039	0		29	10	S4802_039_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	1	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	039	0		29	10	S4802_039_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	039	0		29	10	S4802_039_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	039	0		29	10	S4802_039_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	040	0		29	10	S4802_040_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	040	0		29	10	S4802_040_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	040	0		29	10	S4802_040_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	040	0		29	10	S4802_040_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	040	0		29	10	S4802_040_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	040	0		29	10	S4802_040_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	040	0		29	10	S4802_040_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	040	0		29	10	S4802_040_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	041	0		29	10	S4802_041_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	041	0		29	10	S4802_041_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	041	0		29	10	S4802_041_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	041	0		29	10	S4802_041_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	041	0		29	10	S4802_041_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	041	0		29	10	S4802_041_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	041	0		29	10	S4802_041_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	041	0		29	10	S4802_041_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	042	0		29	10	S4802_042_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	042	0		29	10	S4802_042_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	042	0		29	10	S4802_042_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	042	0		29	10	S4802_042_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	042	0		29	10	S4802_042_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	042	0		29	10	S4802_042_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	042	0		29	10	S4802_042_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	042	0		29	10	S4802_042_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	043	0		29	10	S4802_043_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	043	0		29	10	S4802_043_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	043	0		29	10	S4802_043_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	043	0		29	10	S4802_043_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	043	0		29	10	S4802_043_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	043	0		29	10	S4802_043_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	043	0		29	10	S4802_043_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	043	0		29	10	S4802_043_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	044	0		29	10	S4802_044_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	044	0		29	10	S4802_044_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	044	0		29	10	S4802_044_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	044	0		29	10	S4802_044_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	044	0		29	10	S4802_044_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	044	0		29	10	S4802_044_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	044	0		29	10	S4802_044_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	044	0		29	10	S4802_044_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	045	0		29	10	S4802_045_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	045	0		29	10	S4802_045_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	045	0		29	10	S4802_045_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	045	0		29	10	S4802_045_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	045	0		29	10	S4802_045_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	045	0		29	10	S4802_045_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	045	0		29	10	S4802_045_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	045	0		29	10	S4802_045_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	046	0		29	10	S4802_046_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	046	0		29	10	S4802_046_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	046	0		29	10	S4802_046_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	046	0		29	10	S4802_046_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	046	0		29	10	S4802_046_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	046	0		29	10	S4802_046_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	046	0		29	10	S4802_046_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	046	0		29	10	S4802_046_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	047	0		29	10	S4802_047_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	047	0		29	10	S4802_047_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	047	0		29	10	S4802_047_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	047	0		29	10	S4802_047_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	047	0		29	10	S4802_047_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	047	0		29	10	S4802_047_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	047	0		29	10	S4802_047_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	047	0		29	10	S4802_047_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	048	0		29	10	S4802_048_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	048	0		29	10	S4802_048_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	048	0		29	10	S4802_048_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	048	0		29	10	S4802_048_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	048	0		29	10	S4802_048_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	048	0		29	10	S4802_048_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	048	0		29	10	S4802_048_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	048	0		29	10	S4802_048_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	049	0		29	10	S4802_049_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	049	0		29	10	S4802_049_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	049	0		29	10	S4802_049_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	049	0		29	10	S4802_049_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	049	0		29	10	S4802_049_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	049	0		29	10	S4802_049_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	049	0		29	10	S4802_049_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	049	0		29	10	S4802_049_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	050	0		29	10	S4802_050_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	050	0		29	10	S4802_050_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	050	0		29	10	S4802_050_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	050	0		29	10	S4802_050_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	050	0		29	10	S4802_050_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	050	0		29	10	S4802_050_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	050	0		29	10	S4802_050_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	050	0		29	10	S4802_050_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	051	0		29	10	S4802_051_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	051	0		29	10	S4802_051_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	051	0		29	10	S4802_051_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	051	0		29	10	S4802_051_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	051	0		29	10	S4802_051_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	051	0		29	10	S4802_051_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	051	0		29	10	S4802_051_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	051	0		29	10	S4802_051_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	052	0		29	10	S4802_052_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	052	0		29	10	S4802_052_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	052	0		29	10	S4802_052_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	052	0		29	10	S4802_052_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	052	0		29	10	S4802_052_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	052	0		29	10	S4802_052_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	052	0		29	10	S4802_052_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	052	0		29	10	S4802_052_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	053	0		29	10	S4802_053_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	053	0		29	10	S4802_053_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	053	0		29	10	S4802_053_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	053	0		29	10	S4802_053_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	053	0		29	10	S4802_053_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	053	0		29	10	S4802_053_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	053	0		29	10	S4802_053_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	053	0		29	10	S4802_053_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	054	0		29	10	S4802_054_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	054	0		29	10	S4802_054_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	054	0		29	10	S4802_054_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	054	0		29	10	S4802_054_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	054	0		29	10	S4802_054_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	054	0		29	10	S4802_054_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	054	0		29	10	S4802_054_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	054	0		29	10	S4802_054_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	055	0		29	10	S4802_055_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	055	0		29	10	S4802_055_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	055	0		29	10	S4802_055_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	055	0		29	10	S4802_055_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	055	0		29	10	S4802_055_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	055	0		29	10	S4802_055_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	055	0		29	10	S4802_055_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	055	0		29	10	S4802_055_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	056	0		29	10	S4802_056_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	056	0		29	10	S4802_056_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	056	0		29	10	S4802_056_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	056	0		29	10	S4802_056_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	056	0		29	10	S4802_056_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	056	0		29	10	S4802_056_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	056	0		29	10	S4802_056_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	056	0		29	10	S4802_056_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	057	0		29	10	S4802_057_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	057	0		29	10	S4802_057_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	057	0		29	10	S4802_057_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	057	0		29	10	S4802_057_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	057	0		29	10	S4802_057_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	057	0		29	10	S4802_057_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	057	0		29	10	S4802_057_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	057	0		29	10	S4802_057_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	058	0		29	10	S4802_058_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	058	0		29	10	S4802_058_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	058	0		29	10	S4802_058_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	058	0		29	10	S4802_058_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	058	0		29	10	S4802_058_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	058	0		29	10	S4802_058_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	058	0		29	10	S4802_058_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	058	0		29	10	S4802_058_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	059	0		29	10	S4802_059_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	059	0		29	10	S4802_059_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	059	0		29	10	S4802_059_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	059	0		29	10	S4802_059_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	059	0		29	10	S4802_059_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	059	0		29	10	S4802_059_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	059	0		29	10	S4802_059_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	059	0		29	10	S4802_059_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	060	0		29	10	S4802_060_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	060	0		29	10	S4802_060_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	060	0		29	10	S4802_060_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	060	0		29	10	S4802_060_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	060	0		29	10	S4802_060_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	060	0		29	10	S4802_060_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	060	0		29	10	S4802_060_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	060	0		29	10	S4802_060_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	061	0		29	10	S4802_061_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	061	0		29	10	S4802_061_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	061	0		29	10	S4802_061_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	061	0		29	10	S4802_061_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	061	0		29	10	S4802_061_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	061	0		29	10	S4802_061_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	061	0		29	10	S4802_061_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	061	0		29	10	S4802_061_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	062	0		29	10	S4802_062_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	062	0		29	10	S4802_062_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	062	0		29	10	S4802_062_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	062	0		29	10	S4802_062_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	062	0		29	10	S4802_062_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	062	0		29	10	S4802_062_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	062	0		29	10	S4802_062_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	062	0		29	10	S4802_062_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	063	0		29	10	S4802_063_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	063	0		29	10	S4802_063_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	063	0		29	10	S4802_063_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	063	0		29	10	S4802_063_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	063	0		29	10	S4802_063_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	063	0		29	10	S4802_063_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	063	0		29	10	S4802_063_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	063	0		29	10	S4802_063_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	064	0		29	10	S4802_064_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	064	0		29	10	S4802_064_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	064	0		29	10	S4802_064_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	064	0		29	10	S4802_064_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	064	0		29	10	S4802_064_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	064	0		29	10	S4802_064_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	064	0		29	10	S4802_064_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	064	0		29	10	S4802_064_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	065	0		29	10	S4802_065_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	065	0		29	10	S4802_065_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	065	0		29	10	S4802_065_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	065	0		29	10	S4802_065_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	065	0		29	10	S4802_065_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4802	065	0		29	10	S4802_065_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	065	0		29	10	S4802_065_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	065	0		29	10	S4802_065_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	066	0		29	10	S4802_066_0	4	1	1	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00									4
S4802	066	0		29	10	S4802_066_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	30	90										10		90								Preferred Brand	1	2		011000000000101000000	Preferred Brand																						Preferred Brand	25.00	75.00										25.00		50.00									4
S4802	066	0		29	10	S4802_066_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	30	90										10		30								Non-Preferred Brand	1	1	011000000000101000000		Non-Preferred Brand	25	25										25		25								Non-Preferred Brand																							4
S4802	066	0		29	10	S4802_066_0	4	4	1	Specialty	000010	1	1	Specialty	011000000000101000000	30	90										10		90								Specialty	2	1	011000000000101000000		Specialty	25	25										25		25								Specialty																							4
S4802	066	0		29	10	S4802_066_0	4	1	3	Generic	010000	1	2	Generic	011000000000101000000	30	90										10		90								Generic	2	2		011000000000101000000	Generic																						Generic	0.00	0.00										0.00		0.00								1	4
S4802	066	0		29	10	S4802_066_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S4802	066	0		29	10	S4802_066_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S4802	066	0		29	10	S4802_066_0	4	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S4877	001	0		29	10	S4877_001_0	2	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	40.00	120.00								40.00	120.00			120.00									4
S4877	001	0		29	10	S4877_001_0	2	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00			90.00									4
S4877	001	0		29	10	S4877_001_0	2	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00									4
S4877	001	0		29	10	S4877_001_0	2	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	2	2		011000000011001000000	Tier 4																						Tier 4	40.00	120.00								40.00	120.00			120.00									4
S4877	002	0		29	10	S4877_002_0	2	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00								1	4
S4877	002	0		29	10	S4877_002_0	2	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S4877	002	0		29	10	S4877_002_0	2	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S4877	002	0		29	10	S4877_002_0	2	4	1	Tier 4	010010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	2	2		011000000011001000000	Tier 4																						Tier 4	40.00	120.00								40.00	120.00			120.00									4
S4877	002	0		29	10	S4877_002_0	2	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	2	2		011000000011001000000	Tier 3																						Tier 3	40.00	120.00								40.00	120.00			120.00									4
S4877	002	0		29	10	S4877_002_0	2	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S4877	002	0		29	10	S4877_002_0	2	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	2	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S4877	002	0		29	10	S4877_002_0	2	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	2	2		011000000011001000000	Tier 2																						Tier 2	30.00	90.00								30.00	90.00			90.00									4
S5540	004	0		29	10	S5540_004_0	2	1	1	Generic	010000	1	2	Generic	011100000010011100000	30	90	60							30			30	90	60							Generic	2	2		011100000010011100000	Generic																						Generic	5.00	15.00	10.00							5.00			5.00	15.00	10.00								4
S5540	004	0		29	10	S5540_004_0	2	2	1	Brand	000010	1	2	Brand	011100000010011100000	30	90	60							30			30	90	60							Brand	2	2		011100000010011100000	Brand																						Brand	28.00	84.00	56.00							28.00			28.00	84.00	56.00								4
S5540	004	0		29	10	S5540_004_0	2	3	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5540	004	0		29	10	S5540_004_0	2	1	3	Generic	010000	1	2	Generic	011100000010011100000	30	90	60							30			30	90	60							Generic	2	2		011100000010011100000	Generic																						Generic	5.00	15.00	10.00							5.00			5.00	15.00	10.00							1	4
S5540	004	0		29	10	S5540_004_0	2	2	3	Brand	000010	1	2	Brand																							Brand					Brand																						Brand																						2	4
S5540	004	0		29	10	S5540_004_0	2	3	1	Specialty	010010	1	1	Specialty	011100000010011100000	30	90	60							30			30	90	60							Specialty	2	1	011100000010011100000		Specialty	25	25	25							25			25	25	25							Specialty																							4
S5552	001	0		29	10	S5552_001_0	3	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5552	001	0		29	10	S5552_001_0	3	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5552	001	0		29	10	S5552_001_0	3	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5552	001	0		29	10	S5552_001_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5552	002	0		29	10	S5552_002_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5552	002	0		29	10	S5552_002_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5552	002	0		29	10	S5552_002_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5552	002	0		29	10	S5552_002_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5552	002	0		29	10	S5552_002_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5552	002	0		29	10	S5552_002_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5552	002	0		29	10	S5552_002_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5552	002	0		29	10	S5552_002_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5555	001	0		29	10	S5555_001_0	8	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	7.00	14.00								7.00	14.00			14.00									3
S5555	001	0		29	10	S5555_001_0	8	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	35.00	70.00								35.00	70.00			70.00									3
S5555	001	0		29	10	S5555_001_0	8	4	1	Specialty Drugs	110001		1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							3
S5555	001	0		29	10	S5555_001_0	8	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	70.00	140.00								70.00	140.00			140.00									3
S5555	002	0		29	10	S5555_002_0	8	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	5.00	10.00								5.00	10.00			10.00									4
S5555	002	0		29	10	S5555_002_0	8	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011000000011001000000	30	90								30	90			90								Non Preferred Brand	1	2		011000000011001000000	Non Preferred Brand																						Non Preferred Brand	30.00	60.00								30.00	60.00			60.00									4
S5555	002	0		29	10	S5555_002_0	8	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	15.00	30.00								15.00	30.00			30.00									4
S5555	002	0		29	10	S5555_002_0	8	4	1	Specialty Drugs	110001	1	1	Specialty Drugs	011000000011001000000	30	90								30	90			90								Specialty Drugs	1	1	011000000011001000000		Specialty Drugs	25	25								25	25			25								Specialty Drugs																							4
S5557	002	0		29	10	S5557_002_0	2	3	1	Tier 3	000010		1	Tier 3	010000000010010000000	30									30			30									Tier 3	2	1	010000000010010000000		Tier 3	26									26			26									Tier 3																							3
S5557	002	0		29	10	S5557_002_0	2	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				12.50									3
S5557	002	0		29	10	S5557_002_0	2	2	1	Tier 2	000010		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				100.00									3
S5557	003	0		29	10	S5557_003_0	3	3	1	Tier 3	000010		1	Tier 3	010000000010010000000	30									30			30									Tier 3	2	1	010000000010010000000		Tier 3	26									26			26									Tier 3																							3
S5557	003	0		29	10	S5557_003_0	3	2	1	Tier 2	000010		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				100.00									3
S5557	003	0		29	10	S5557_003_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				12.50									3
S5557	004	0		29	10	S5557_004_0	2	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				12.50									3
S5557	004	0		29	10	S5557_004_0	2	3	1	Tier 3	000010		1	Tier 3	010000000010010000000	30									30			30									Tier 3	2	1	010000000010010000000		Tier 3	26									26			26									Tier 3																							3
S5557	004	0		29	10	S5557_004_0	2	2	1	Tier 2	000010		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				100.00									3
S5557	005	0		29	10	S5557_005_0	2	3	1	Tier 3	000010		1	Tier 3	010000000010010000000	30									30			30									Tier 3	2	1	010000000010010000000		Tier 3	26									26			26									Tier 3																							3
S5557	005	0		29	10	S5557_005_0	2	2	1	Tier 2	000010		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				100.00									3
S5557	005	0		29	10	S5557_005_0	2	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				12.50									3
S5557	006	0		29	10	S5557_006_0	2	3	1	Tier 3	000010		1	Tier 3	010000000010010000000	30									30			30									Tier 3	2	1	010000000010010000000		Tier 3	26									26			26									Tier 3																							3
S5557	006	0		29	10	S5557_006_0	2	2	1	Tier 2	000010		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	40.00	120.00								40.00				100.00									3
S5557	006	0		29	10	S5557_006_0	2	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				12.50									3
S5557	007	0		29	10	S5557_007_0	2	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5557	007	0		29	10	S5557_007_0	2	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				12.60								1	4
S5557	007	0		29	10	S5557_007_0	2	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5557	007	0		29	10	S5557_007_0	2	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5557	007	0		29	10	S5557_007_0	2	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				12.60									4
S5557	007	0		29	10	S5557_007_0	2	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	35.00	105.00								35.00				73.50									4
S5557	007	0		29	10	S5557_007_0	2	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	85.00	255.00								85.00				178.50									4
S5557	007	0		29	10	S5557_007_0	2	4	1	Tier 4	000010	1	1	Tier 4	010000000010010000000	30									30			30									Tier 4	2	1	010000000010010000000		Tier 4	33									33			33									Tier 4																							4
S5557	008	0		29	10	S5557_008_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				9.00									4
S5557	008	0		29	10	S5557_008_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	89.00	267.00								89.00				133.50									4
S5557	008	0		29	10	S5557_008_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				58.50									4
S5557	008	0		29	10	S5557_008_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5557	008	0		29	10	S5557_008_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5557	008	0		29	10	S5557_008_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5557	008	0		29	10	S5557_008_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				9.00								1	4
S5557	008	0		29	10	S5557_008_0	1	4	1	Tier 4	000010	1	1	Tier 4	010000000010010000000	30									30			30									Tier 4	2	1	010000000010010000000		Tier 4	33									33			33									Tier 4																							4
S5557	009	0		29	10	S5557_009_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	89.00	267.00								89.00				133.50									4
S5557	009	0		29	10	S5557_009_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	39.00	117.00								39.00				58.50									4
S5557	009	0		29	10	S5557_009_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				9.00									4
S5557	009	0		29	10	S5557_009_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5557	009	0		29	10	S5557_009_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5557	009	0		29	10	S5557_009_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5557	009	0		29	10	S5557_009_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				9.00								1	4
S5557	009	0		29	10	S5557_009_0	1	4	1	Tier 4	000010	1	1	Tier 4	010000000010010000000	30									30			30									Tier 4	2	1	010000000010010000000		Tier 4	33									33			33									Tier 4																							4
S5557	010	0		29	10	S5557_010_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				12.60									4
S5557	010	0		29	10	S5557_010_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	35.00	105.00								35.00				73.50									4
S5557	010	0		29	10	S5557_010_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5557	010	0		29	10	S5557_010_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5557	010	0		29	10	S5557_010_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5557	010	0		29	10	S5557_010_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				12.60								1	4
S5557	010	0		29	10	S5557_010_0	1	4	1	Tier 4	000010	1	1	Tier 4	010000000010010000000	30									30			30									Tier 4	2	1	010000000010010000000		Tier 4	33									33			33									Tier 4																							4
S5557	010	0		29	10	S5557_010_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	85.00	255.00								85.00				178.50									4
S5557	011	0		29	10	S5557_011_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				12.60									4
S5557	011	0		29	10	S5557_011_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	85.00	255.00								85.00				178.50									4
S5557	011	0		29	10	S5557_011_0	1	4	1	Tier 4	000010	1	1	Tier 4	010000000010010000000	30									30			30									Tier 4	2	1	010000000010010000000		Tier 4	33									33			33									Tier 4																							4
S5557	011	0		29	10	S5557_011_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	6.00	18.00								6.00				12.60								1	4
S5557	011	0		29	10	S5557_011_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5557	011	0		29	10	S5557_011_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5557	011	0		29	10	S5557_011_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	35.00	105.00								35.00				73.50									4
S5557	011	0		29	10	S5557_011_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5566	001	0		29	10	S5566_001_0	2	4	1	Specialty	010010		1	Specialty	000001011010000000000					90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							2
S5566	001	0		29	10	S5566_001_0	2	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				39.00	98.00		39.00	117.00		47.00				98.00									2
S5566	001	0		29	10	S5566_001_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				18.00	45.00		18.00	54.00		22.00				45.00									2
S5566	001	0		29	10	S5566_001_0	2	1	1	Generic	010000		2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				6.00	15.00		6.00	18.00		7.00				15.00									2
S5566	002	0		29	10	S5566_002_0	2	4	1	Specialty	010010		1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							3
S5566	002	0		29	10	S5566_002_0	2	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-preferred Brand	2	2		000011011010001000000	Non-preferred Brand																						Non-preferred Brand				52.00	130.00		52.00	156.00		62.00				130.00									3
S5566	002	0		29	10	S5566_002_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				32.00	80.00		32.00	96.00		38.00				80.00									3
S5566	002	0		29	10	S5566_002_0	2	1	1	Generic	010000		2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				10.00	25.00		10.00	30.00		12.00				25.00									3
S5566	003	0		29	10	S5566_003_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5566	003	0		29	10	S5566_003_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5566	003	0		29	10	S5566_003_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5566	003	0		29	10	S5566_003_0	2	1	3	Generic	010000	1	2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				10.00	25.00		10.00	30.00		12.00				25.00								1	4
S5566	003	0		29	10	S5566_003_0	2	4	1	Specialty	010010	1	1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							4
S5566	003	0		29	10	S5566_003_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				52.00	130.00		52.00	156.00		62.00				130.00									4
S5566	003	0		29	10	S5566_003_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				32.00	80.00		32.00	96.00		38.00				80.00									4
S5566	003	0		29	10	S5566_003_0	2	1	1	Generic	010000	1	2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				10.00	25.00		10.00	30.00		12.00				25.00									4
S5569	003	0		29	10	S5569_003_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5569	003	0		29	10	S5569_003_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	63.00	189.00								63.00													3
S5569	003	0		29	10	S5569_003_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5569	003	0		29	10	S5569_003_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5569	004	0		29	10	S5569_004_0	6	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5569	004	0		29	10	S5569_004_0	6	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5569	004	0		29	10	S5569_004_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5569	004	0		29	10	S5569_004_0	6	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5569	004	0		29	10	S5569_004_0	6	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00													4
S5569	004	0		29	10	S5569_004_0	6	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5569	004	0		29	10	S5569_004_0	6	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5569	004	0		29	10	S5569_004_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	24.00	72.00								24.00													4
S5580	003	0		29	10	S5580_003_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5580	003	0		29	10	S5580_003_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5580	003	0		29	10	S5580_003_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5580	003	0		29	10	S5580_003_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5584	001	0		29	10	S5584_001_0	3	5	1	Non Self-Administered Injectable	010010		2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							2
S5584	001	0		29	10	S5584_001_0	3	4	1	Specialty	010010		1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							2
S5584	001	0		29	10	S5584_001_0	3	3	1	Non-Preferred	100100		2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			2
S5584	001	0		29	10	S5584_001_0	3	1	1	Generic	010000		2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			2
S5584	001	0		29	10	S5584_001_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			2
S5584	002	0		29	10	S5584_002_0	3	5	1	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable	010000000010000000000	34									34												Non Self-Administered Injectable	2	1	010000000010000000000		Non Self-Administered Injectable	25									25												Non Self-Administered Injectable																							4
S5584	002	0		29	10	S5584_002_0	3	4	1	Specialty	010010	1	1	Specialty	010000000010010000000	34									34			34									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5584	002	0		29	10	S5584_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5584	002	0		29	10	S5584_002_0	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5584	002	0		29	10	S5584_002_0	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5584	002	0		29	10	S5584_002_0	3	5	3	Non Self-Administered Injectable	010010	1	2	Non Self-Administered Injectable																							Non Self-Administered Injectable					Non Self-Administered Injectable																						Non Self-Administered Injectable																						2	4
S5584	002	0		29	10	S5584_002_0	3	1	3	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00		1	4
S5584	002	0		29	10	S5584_002_0	3	1	1	Generic	010000	3	2	Generic	010001001010010001001	34				90			90		34			34				90			90		Generic	2	2		010001001010010001001	Generic																						Generic	5.00				12.50			15.00		5.00			5.00				12.50			15.00			4
S5584	002	0		29	10	S5584_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	010001001010010001001	34				90			90		34			34				90			90		Preferred Brand	2	2		010001001010010001001	Preferred Brand																						Preferred Brand	25.00				62.50			75.00		25.00			25.00				62.50			75.00			4
S5584	002	0		29	10	S5584_002_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	010001001010010001001	34				90			90		34			34				90			90		Non-Preferred	2	2		010001001010010001001	Non-Preferred																						Non-Preferred	50.00				125.00			150.00		50.00			50.00				125.00			150.00			4
S5585	001	0		29	10	S5585_001_0	4	1	1	Formulary Generic	001000		2	Formulary Generic	011000000011011000000	30	90								30	90		30	90								Formulary Generic	2	2		011000000011011000000	Formulary Generic																						Formulary Generic	5.00	10.00								5.00	10.00		5.00	10.00									3
S5585	001	0		29	10	S5585_001_0	4	4	1	Specialty Injectibles	100001		1	Specialty Injectibles	011000000011011000000	30	90								30	90		30	90								Specialty Injectibles	2	1	011000000011011000000		Specialty Injectibles	30	20								30	20		30	20								Specialty Injectibles																							3
S5585	001	0		29	10	S5585_001_0	4	3	1	Non-Preferred Brand/Generic	100100		2	Non-Preferred Brand/Generic	011000000011011000000	30	90								30	90		30	90								Non-Preferred Brand/Generic	2	1	011000000011011000000		Non-Preferred Brand/Generic	50	33								50	33		50	33								Non-Preferred Brand/Generic																							3
S5585	001	0		29	10	S5585_001_0	4	2	1	Formulary Brand	000001		2	Formulary Brand	011000000011011000000	30	90								30	90		30	90								Formulary Brand	2	2		011000000011011000000	Formulary Brand																						Formulary Brand	30.00	60.00								30.00	60.00		30.00	60.00									3
S5588	001	0		29	10	S5588_001_0	4	3	1	Part D Eligible Injectable	010010		2	Part D Eligible Injectable	010000000010000000000	30									30												Part D Eligible Injectable	2	1	010000000010000000000		Part D Eligible Injectable	25									25												Part D Eligible Injectable																							3
S5588	001	0		29	10	S5588_001_0	4	2	1	Brand	000010		2	Brand	011000000010011000000	30	90								30			30	90								Brand	2	2		011000000010011000000	Brand																						Brand	40.00	80.00								40.00			40.00	80.00									3
S5588	001	0		29	10	S5588_001_0	4	4	1	Specialty	010010		1	Specialty	010000000010000000000	30									30												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							3
S5588	001	0		29	10	S5588_001_0	4	1	1	Generic	010000		2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	6.00	12.00								6.00			6.00	12.00									3
S5588	002	0		29	10	S5588_002_0	4	1	1	Generic	010000	1	2	Generic	011000000010011000000	30	90								30			30	90								Generic	2	2		011000000010011000000	Generic																						Generic	5.00	10.00								5.00			5.00	10.00									4
S5588	002	0		29	10	S5588_002_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	25.00	50.00								25.00			25.00	50.00									4
S5588	002	0		29	10	S5588_002_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010011000000	30	90								30			30	90								Non-Preferred Brand	2	2		011000000010011000000	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00			50.00	150.00									4
S5588	002	0		29	10	S5588_002_0	4	4	1	Multisource Brand (MSB) and Isomeric	000010	1	2	Multisource Brand (MSB) and Isomeric	010000000010000000000	30									30												Multisource Brand (MSB) and Isomeric	2	2		010000000010000000000	Multisource Brand (MSB) and Isomeric																						Multisource Brand (MSB) and Isomeric	50.00									50.00													4
S5588	002	0		29	10	S5588_002_0	4	6	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
S5588	002	0		29	10	S5588_002_0	4	5	1	Part D Eligible Injectable	010010	1	2	Part D Eligible Injectable	010000000010000000000	30									30												Part D Eligible Injectable	2	1	010000000010000000000		Part D Eligible Injectable	25									25												Part D Eligible Injectable																							4
S5593	002	0		29	10	S5593_002_0	1	3	1	Non Preferred Brand	100000		2	Non Preferred Brand	011000000011011000000	34	90								34	90		34	90								Non Preferred Brand	1	2		011000000011011000000	Non Preferred Brand																						Non Preferred Brand	50.00	150.00								50.00	150.00		125.00	125.00									3
S5593	002	0		29	10	S5593_002_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00	87.00		72.50	72.50									3
S5593	002	0		29	10	S5593_002_0	1	1	1	Generic	011100		2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	6.00	18.00								6.00	18.00		15.00	15.00									3
S5593	002	0		29	10	S5593_002_0	1	4	1	Specialty	111111		1	Specialty	011000000011011000000	34	90								34	90		34	90								Specialty	1	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5593	003	0		29	10	S5593_003_0	2	3	1	Non Preferred Brand	100000	1	2	Non Preferred Brand	011000000011011000000	34	90								34	90		34	90								Non Preferred Brand	1	2		011000000011011000000	Non Preferred Brand																						Non Preferred Brand	45.00	135.00								45.00	135.00		112.50	112.50									4
S5593	003	0		29	10	S5593_003_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00		50.00	50.00									4
S5593	003	0		29	10	S5593_003_0	2	1	1	Generic	011100	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	6.00	18.00								6.00	18.00		15.00	15.00									4
S5593	003	0		29	10	S5593_003_0	2	4	1	Specialty	111111	1	1	Specialty	011000000011011000000	34	90								34	90		34	90								Specialty	1	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							4
S5593	003	0		29	10	S5593_003_0	2	4	3	Specialty	111111	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5593	003	0		29	10	S5593_003_0	2	3	3	Non Preferred Brand	100000	1	2	Non Preferred Brand																							Non Preferred Brand					Non Preferred Brand																						Non Preferred Brand																						2	4
S5593	003	0		29	10	S5593_003_0	2	1	3	Generic	011100	1	2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	6.00	18.00								6.00	18.00		15.00	15.00								1	4
S5593	003	0		29	10	S5593_003_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5593	004	0		29	10	S5593_004_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	1	2		011000000011011000000	Preferred Brand																						Preferred Brand	27.00	81.00								27.00	81.00		67.50	67.50									3
S5593	004	0		29	10	S5593_004_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011011000000	34	90								34	90		34	90								Preferred Generic	2	2		011000000011011000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00	6.00		5.00	5.00									3
S5593	004	0		29	10	S5593_004_0	4	3	1	Specialty	001001		1	Specialty	011000000011011000000	34	90								34	90		34	90								Specialty	1	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5596	001	0		29	10	S5596_001_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			30		Specialty Injectables																							4
S5596	001	0		29	10	S5596_001_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			30		Non-Specialty Injectables																							4
S5596	001	0		29	10	S5596_001_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	001	0		29	10	S5596_001_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			4
S5596	001	0		29	10	S5596_001_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							20.00			24.00			4
S5596	003	0		29	10	S5596_003_0	6	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	003	0		29	10	S5596_003_0	6	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	003	0		29	10	S5596_003_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	003	0		29	10	S5596_003_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	003	0		29	10	S5596_003_0	6	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							20.00			24.00		1	4
S5596	003	0		29	10	S5596_003_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			30		Specialty Injectables																							4
S5596	003	0		29	10	S5596_003_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			30		Non-Specialty Injectables																							4
S5596	003	0		29	10	S5596_003_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00							135.00			162.00			4
S5596	003	0		29	10	S5596_003_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	24.00	72.00								24.00							60.00			72.00			4
S5596	003	0		29	10	S5596_003_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							20.00			24.00			4
S5596	005	0		29	10	S5596_005_0	4	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5596	005	0		29	10	S5596_005_0	4	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5596	005	0		29	10	S5596_005_0	4	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5596	005	0		29	10	S5596_005_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5596	005	0		29	10	S5596_005_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5596	006	0		29	10	S5596_006_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	006	0		29	10	S5596_006_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	006	0		29	10	S5596_006_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	006	0		29	10	S5596_006_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	006	0		29	10	S5596_006_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	007	0		29	10	S5596_007_0	5	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	007	0		29	10	S5596_007_0	5	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	007	0		29	10	S5596_007_0	5	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5596	007	0		29	10	S5596_007_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	007	0		29	10	S5596_007_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	007	0		29	10	S5596_007_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	007	0		29	10	S5596_007_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	007	0		29	10	S5596_007_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	007	0		29	10	S5596_007_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	007	0		29	10	S5596_007_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	009	0		29	10	S5596_009_0	4	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5596	009	0		29	10	S5596_009_0	4	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5596	009	0		29	10	S5596_009_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5596	009	0		29	10	S5596_009_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5596	009	0		29	10	S5596_009_0	4	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5596	010	0		29	10	S5596_010_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	010	0		29	10	S5596_010_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	010	0		29	10	S5596_010_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	010	0		29	10	S5596_010_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	010	0		29	10	S5596_010_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	011	0		29	10	S5596_011_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	011	0		29	10	S5596_011_0	4	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5596	011	0		29	10	S5596_011_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	011	0		29	10	S5596_011_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	011	0		29	10	S5596_011_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	011	0		29	10	S5596_011_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	011	0		29	10	S5596_011_0	4	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	011	0		29	10	S5596_011_0	4	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	011	0		29	10	S5596_011_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	011	0		29	10	S5596_011_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	013	0		29	10	S5596_013_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5596	013	0		29	10	S5596_013_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5596	013	0		29	10	S5596_013_0	3	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5596	013	0		29	10	S5596_013_0	3	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5596	013	0		29	10	S5596_013_0	3	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5596	014	0		29	10	S5596_014_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	014	0		29	10	S5596_014_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	014	0		29	10	S5596_014_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	014	0		29	10	S5596_014_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	014	0		29	10	S5596_014_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	015	0		29	10	S5596_015_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	015	0		29	10	S5596_015_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	015	0		29	10	S5596_015_0	6	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	015	0		29	10	S5596_015_0	6	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	015	0		29	10	S5596_015_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	015	0		29	10	S5596_015_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	015	0		29	10	S5596_015_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	015	0		29	10	S5596_015_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	015	0		29	10	S5596_015_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	015	0		29	10	S5596_015_0	6	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5596	017	0		29	10	S5596_017_0	4	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5596	017	0		29	10	S5596_017_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5596	017	0		29	10	S5596_017_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5596	017	0		29	10	S5596_017_0	4	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5596	017	0		29	10	S5596_017_0	4	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5596	018	0		29	10	S5596_018_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	018	0		29	10	S5596_018_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	018	0		29	10	S5596_018_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	018	0		29	10	S5596_018_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	018	0		29	10	S5596_018_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	019	0		29	10	S5596_019_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	019	0		29	10	S5596_019_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	019	0		29	10	S5596_019_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	019	0		29	10	S5596_019_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	019	0		29	10	S5596_019_0	6	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	019	0		29	10	S5596_019_0	6	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5596	019	0		29	10	S5596_019_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	019	0		29	10	S5596_019_0	6	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	019	0		29	10	S5596_019_0	6	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	019	0		29	10	S5596_019_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	021	0		29	10	S5596_021_0	5	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5596	021	0		29	10	S5596_021_0	5	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5596	021	0		29	10	S5596_021_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5596	021	0		29	10	S5596_021_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5596	021	0		29	10	S5596_021_0	5	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5596	022	0		29	10	S5596_022_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	022	0		29	10	S5596_022_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	022	0		29	10	S5596_022_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	022	0		29	10	S5596_022_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	022	0		29	10	S5596_022_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	023	0		29	10	S5596_023_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	023	0		29	10	S5596_023_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	023	0		29	10	S5596_023_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	023	0		29	10	S5596_023_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	023	0		29	10	S5596_023_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	023	0		29	10	S5596_023_0	4	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5596	023	0		29	10	S5596_023_0	4	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	023	0		29	10	S5596_023_0	4	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	023	0		29	10	S5596_023_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	023	0		29	10	S5596_023_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	025	0		29	10	S5596_025_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5596	025	0		29	10	S5596_025_0	5	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5596	025	0		29	10	S5596_025_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5596	025	0		29	10	S5596_025_0	5	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5596	025	0		29	10	S5596_025_0	5	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5596	026	0		29	10	S5596_026_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	026	0		29	10	S5596_026_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	026	0		29	10	S5596_026_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	026	0		29	10	S5596_026_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	026	0		29	10	S5596_026_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	027	0		29	10	S5596_027_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	027	0		29	10	S5596_027_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	027	0		29	10	S5596_027_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	027	0		29	10	S5596_027_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	027	0		29	10	S5596_027_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	027	0		29	10	S5596_027_0	4	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	027	0		29	10	S5596_027_0	4	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	027	0		29	10	S5596_027_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	027	0		29	10	S5596_027_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	027	0		29	10	S5596_027_0	4	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5596	029	0		29	10	S5596_029_0	5	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5596	029	0		29	10	S5596_029_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5596	029	0		29	10	S5596_029_0	5	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5596	029	0		29	10	S5596_029_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5596	029	0		29	10	S5596_029_0	5	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5596	030	0		29	10	S5596_030_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	030	0		29	10	S5596_030_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	030	0		29	10	S5596_030_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	030	0		29	10	S5596_030_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	030	0		29	10	S5596_030_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	031	0		29	10	S5596_031_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	031	0		29	10	S5596_031_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	031	0		29	10	S5596_031_0	4	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	031	0		29	10	S5596_031_0	4	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	031	0		29	10	S5596_031_0	4	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5596	031	0		29	10	S5596_031_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	031	0		29	10	S5596_031_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	031	0		29	10	S5596_031_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	031	0		29	10	S5596_031_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	031	0		29	10	S5596_031_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	033	0		29	10	S5596_033_0	5	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5596	033	0		29	10	S5596_033_0	5	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5596	033	0		29	10	S5596_033_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5596	033	0		29	10	S5596_033_0	5	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5596	033	0		29	10	S5596_033_0	5	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5596	034	0		29	10	S5596_034_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	034	0		29	10	S5596_034_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	034	0		29	10	S5596_034_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	034	0		29	10	S5596_034_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	034	0		29	10	S5596_034_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	035	0		29	10	S5596_035_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	035	0		29	10	S5596_035_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	035	0		29	10	S5596_035_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	035	0		29	10	S5596_035_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	035	0		29	10	S5596_035_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	035	0		29	10	S5596_035_0	4	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5596	035	0		29	10	S5596_035_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	035	0		29	10	S5596_035_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	035	0		29	10	S5596_035_0	4	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	035	0		29	10	S5596_035_0	4	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	043	0		29	10	S5596_043_0	4	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5596	043	0		29	10	S5596_043_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5596	043	0		29	10	S5596_043_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5596	043	0		29	10	S5596_043_0	4	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5596	043	0		29	10	S5596_043_0	4	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5596	044	0		29	10	S5596_044_0	6	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	044	0		29	10	S5596_044_0	6	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	044	0		29	10	S5596_044_0	6	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	044	0		29	10	S5596_044_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	044	0		29	10	S5596_044_0	6	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	045	0		29	10	S5596_045_0	7	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5596	045	0		29	10	S5596_045_0	7	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5596	045	0		29	10	S5596_045_0	7	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5596	045	0		29	10	S5596_045_0	7	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5596	045	0		29	10	S5596_045_0	7	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5596	045	0		29	10	S5596_045_0	7	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5596	045	0		29	10	S5596_045_0	7	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5596	045	0		29	10	S5596_045_0	7	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5596	045	0		29	10	S5596_045_0	7	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5596	045	0		29	10	S5596_045_0	7	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5596	046	0		29	10	S5596_046_0	7	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								30							25			25		Specialty Injectables																							2
S5596	046	0		29	10	S5596_046_0	7	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								30							25			25		Non-Specialty Injectables																							2
S5596	046	0		29	10	S5596_046_0	7	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	54.00	162.00								54.00							135.00			162.00			2
S5596	046	0		29	10	S5596_046_0	7	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	25.00	75.00								25.00							62.50			75.00			2
S5596	046	0		29	10	S5596_046_0	7	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	8.00	24.00								8.00							20.00			24.00			2
S5597	034	0		29	10	S5597_034_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	034	0		29	10	S5597_034_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	034	0		29	10	S5597_034_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	035	0		29	10	S5597_035_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	035	0		29	10	S5597_035_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	035	0		29	10	S5597_035_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	036	0		29	10	S5597_036_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	036	0		29	10	S5597_036_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	036	0		29	10	S5597_036_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	037	0		29	10	S5597_037_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	037	0		29	10	S5597_037_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	037	0		29	10	S5597_037_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	038	0		29	10	S5597_038_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	038	0		29	10	S5597_038_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	038	0		29	10	S5597_038_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	039	0		29	10	S5597_039_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	039	0		29	10	S5597_039_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	039	0		29	10	S5597_039_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	040	0		29	10	S5597_040_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	040	0		29	10	S5597_040_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	040	0		29	10	S5597_040_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	041	0		29	10	S5597_041_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	041	0		29	10	S5597_041_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	041	0		29	10	S5597_041_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	042	0		29	10	S5597_042_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	042	0		29	10	S5597_042_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	042	0		29	10	S5597_042_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	043	0		29	10	S5597_043_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	043	0		29	10	S5597_043_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	043	0		29	10	S5597_043_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	044	0		29	10	S5597_044_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	044	0		29	10	S5597_044_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	044	0		29	10	S5597_044_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	045	0		29	10	S5597_045_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	045	0		29	10	S5597_045_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	045	0		29	10	S5597_045_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	046	0		29	10	S5597_046_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	046	0		29	10	S5597_046_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	046	0		29	10	S5597_046_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	047	0		29	10	S5597_047_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	047	0		29	10	S5597_047_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	047	0		29	10	S5597_047_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	048	0		29	10	S5597_048_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	048	0		29	10	S5597_048_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	048	0		29	10	S5597_048_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	049	0		29	10	S5597_049_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	049	0		29	10	S5597_049_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	049	0		29	10	S5597_049_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	050	0		29	10	S5597_050_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	050	0		29	10	S5597_050_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	050	0		29	10	S5597_050_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	051	0		29	10	S5597_051_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	051	0		29	10	S5597_051_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	051	0		29	10	S5597_051_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	052	0		29	10	S5597_052_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	052	0		29	10	S5597_052_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	052	0		29	10	S5597_052_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	053	0		29	10	S5597_053_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	053	0		29	10	S5597_053_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	053	0		29	10	S5597_053_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	054	0		29	10	S5597_054_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	054	0		29	10	S5597_054_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	054	0		29	10	S5597_054_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	055	0		29	10	S5597_055_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	055	0		29	10	S5597_055_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	055	0		29	10	S5597_055_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	056	0		29	10	S5597_056_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	056	0		29	10	S5597_056_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	056	0		29	10	S5597_056_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	057	0		29	10	S5597_057_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	057	0		29	10	S5597_057_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	057	0		29	10	S5597_057_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	058	0		29	10	S5597_058_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	058	0		29	10	S5597_058_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	058	0		29	10	S5597_058_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	059	0		29	10	S5597_059_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	059	0		29	10	S5597_059_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	059	0		29	10	S5597_059_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	060	0		29	10	S5597_060_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	060	0		29	10	S5597_060_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	060	0		29	10	S5597_060_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	061	0		29	10	S5597_061_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	061	0		29	10	S5597_061_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	061	0		29	10	S5597_061_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	062	0		29	10	S5597_062_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	062	0		29	10	S5597_062_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	062	0		29	10	S5597_062_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	063	0		29	10	S5597_063_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	063	0		29	10	S5597_063_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	063	0		29	10	S5597_063_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	064	0		29	10	S5597_064_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	064	0		29	10	S5597_064_0	3	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5597	064	0		29	10	S5597_064_0	3	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	199	0		29	10	S5597_199_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	199	0		29	10	S5597_199_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	199	0		29	10	S5597_199_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	199	0		29	10	S5597_199_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	199	0		29	10	S5597_199_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	199	0		29	10	S5597_199_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	199	0		29	10	S5597_199_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	199	0		29	10	S5597_199_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	200	0		29	10	S5597_200_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	200	0		29	10	S5597_200_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	200	0		29	10	S5597_200_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	200	0		29	10	S5597_200_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	200	0		29	10	S5597_200_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	200	0		29	10	S5597_200_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	200	0		29	10	S5597_200_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	200	0		29	10	S5597_200_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	201	0		29	10	S5597_201_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	201	0		29	10	S5597_201_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	201	0		29	10	S5597_201_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	201	0		29	10	S5597_201_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	201	0		29	10	S5597_201_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	201	0		29	10	S5597_201_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	201	0		29	10	S5597_201_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	201	0		29	10	S5597_201_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	202	0		29	10	S5597_202_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	202	0		29	10	S5597_202_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	202	0		29	10	S5597_202_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	202	0		29	10	S5597_202_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	202	0		29	10	S5597_202_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	202	0		29	10	S5597_202_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	202	0		29	10	S5597_202_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	202	0		29	10	S5597_202_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	203	0		29	10	S5597_203_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	203	0		29	10	S5597_203_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	203	0		29	10	S5597_203_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	203	0		29	10	S5597_203_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	203	0		29	10	S5597_203_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	203	0		29	10	S5597_203_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	203	0		29	10	S5597_203_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	203	0		29	10	S5597_203_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	204	0		29	10	S5597_204_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	204	0		29	10	S5597_204_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	204	0		29	10	S5597_204_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	204	0		29	10	S5597_204_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	204	0		29	10	S5597_204_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	204	0		29	10	S5597_204_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	204	0		29	10	S5597_204_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	204	0		29	10	S5597_204_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	205	0		29	10	S5597_205_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	205	0		29	10	S5597_205_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	205	0		29	10	S5597_205_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	205	0		29	10	S5597_205_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	205	0		29	10	S5597_205_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	205	0		29	10	S5597_205_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	205	0		29	10	S5597_205_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	205	0		29	10	S5597_205_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	206	0		29	10	S5597_206_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	206	0		29	10	S5597_206_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	206	0		29	10	S5597_206_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	206	0		29	10	S5597_206_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	206	0		29	10	S5597_206_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	206	0		29	10	S5597_206_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	206	0		29	10	S5597_206_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	206	0		29	10	S5597_206_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	207	0		29	10	S5597_207_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	207	0		29	10	S5597_207_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	207	0		29	10	S5597_207_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	207	0		29	10	S5597_207_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	207	0		29	10	S5597_207_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	207	0		29	10	S5597_207_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	207	0		29	10	S5597_207_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	207	0		29	10	S5597_207_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	208	0		29	10	S5597_208_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	208	0		29	10	S5597_208_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	208	0		29	10	S5597_208_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	208	0		29	10	S5597_208_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	208	0		29	10	S5597_208_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	208	0		29	10	S5597_208_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	208	0		29	10	S5597_208_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	208	0		29	10	S5597_208_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	209	0		29	10	S5597_209_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	209	0		29	10	S5597_209_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	209	0		29	10	S5597_209_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	209	0		29	10	S5597_209_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	209	0		29	10	S5597_209_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	209	0		29	10	S5597_209_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	209	0		29	10	S5597_209_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	209	0		29	10	S5597_209_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	210	0		29	10	S5597_210_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	210	0		29	10	S5597_210_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	210	0		29	10	S5597_210_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	210	0		29	10	S5597_210_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	210	0		29	10	S5597_210_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	210	0		29	10	S5597_210_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	210	0		29	10	S5597_210_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	210	0		29	10	S5597_210_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	211	0		29	10	S5597_211_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	211	0		29	10	S5597_211_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	211	0		29	10	S5597_211_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	211	0		29	10	S5597_211_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	211	0		29	10	S5597_211_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	211	0		29	10	S5597_211_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	211	0		29	10	S5597_211_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	211	0		29	10	S5597_211_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	212	0		29	10	S5597_212_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	212	0		29	10	S5597_212_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	212	0		29	10	S5597_212_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	212	0		29	10	S5597_212_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	212	0		29	10	S5597_212_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	212	0		29	10	S5597_212_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	212	0		29	10	S5597_212_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	212	0		29	10	S5597_212_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	213	0		29	10	S5597_213_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	213	0		29	10	S5597_213_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	213	0		29	10	S5597_213_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	213	0		29	10	S5597_213_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	213	0		29	10	S5597_213_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	213	0		29	10	S5597_213_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	213	0		29	10	S5597_213_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	213	0		29	10	S5597_213_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	214	0		29	10	S5597_214_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	214	0		29	10	S5597_214_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	214	0		29	10	S5597_214_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	214	0		29	10	S5597_214_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	214	0		29	10	S5597_214_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	214	0		29	10	S5597_214_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	214	0		29	10	S5597_214_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	214	0		29	10	S5597_214_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	215	0		29	10	S5597_215_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	215	0		29	10	S5597_215_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	215	0		29	10	S5597_215_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	215	0		29	10	S5597_215_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	215	0		29	10	S5597_215_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	215	0		29	10	S5597_215_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	215	0		29	10	S5597_215_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	215	0		29	10	S5597_215_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	216	0		29	10	S5597_216_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	216	0		29	10	S5597_216_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	216	0		29	10	S5597_216_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	216	0		29	10	S5597_216_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	216	0		29	10	S5597_216_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	216	0		29	10	S5597_216_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	216	0		29	10	S5597_216_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	216	0		29	10	S5597_216_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	217	0		29	10	S5597_217_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	217	0		29	10	S5597_217_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	217	0		29	10	S5597_217_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	217	0		29	10	S5597_217_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	217	0		29	10	S5597_217_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	217	0		29	10	S5597_217_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	217	0		29	10	S5597_217_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	217	0		29	10	S5597_217_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	218	0		29	10	S5597_218_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	218	0		29	10	S5597_218_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	218	0		29	10	S5597_218_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	218	0		29	10	S5597_218_0	3	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	218	0		29	10	S5597_218_0	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	218	0		29	10	S5597_218_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	218	0		29	10	S5597_218_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	218	0		29	10	S5597_218_0	3	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	219	0		29	10	S5597_219_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	219	0		29	10	S5597_219_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	219	0		29	10	S5597_219_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	219	0		29	10	S5597_219_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	219	0		29	10	S5597_219_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	219	0		29	10	S5597_219_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	219	0		29	10	S5597_219_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	219	0		29	10	S5597_219_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	220	0		29	10	S5597_220_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	220	0		29	10	S5597_220_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	220	0		29	10	S5597_220_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	220	0		29	10	S5597_220_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	220	0		29	10	S5597_220_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	220	0		29	10	S5597_220_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	220	0		29	10	S5597_220_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	220	0		29	10	S5597_220_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	221	0		29	10	S5597_221_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	221	0		29	10	S5597_221_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	221	0		29	10	S5597_221_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	221	0		29	10	S5597_221_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	221	0		29	10	S5597_221_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	221	0		29	10	S5597_221_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	221	0		29	10	S5597_221_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	221	0		29	10	S5597_221_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	222	0		29	10	S5597_222_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	222	0		29	10	S5597_222_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	222	0		29	10	S5597_222_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	222	0		29	10	S5597_222_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	222	0		29	10	S5597_222_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	222	0		29	10	S5597_222_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	222	0		29	10	S5597_222_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	222	0		29	10	S5597_222_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	223	0		29	10	S5597_223_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	223	0		29	10	S5597_223_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	223	0		29	10	S5597_223_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	223	0		29	10	S5597_223_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	223	0		29	10	S5597_223_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	223	0		29	10	S5597_223_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	223	0		29	10	S5597_223_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	223	0		29	10	S5597_223_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	224	0		29	10	S5597_224_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	224	0		29	10	S5597_224_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	224	0		29	10	S5597_224_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	224	0		29	10	S5597_224_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	224	0		29	10	S5597_224_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	224	0		29	10	S5597_224_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	224	0		29	10	S5597_224_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	224	0		29	10	S5597_224_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	225	0		29	10	S5597_225_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	225	0		29	10	S5597_225_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	225	0		29	10	S5597_225_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	225	0		29	10	S5597_225_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	225	0		29	10	S5597_225_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	225	0		29	10	S5597_225_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	225	0		29	10	S5597_225_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	225	0		29	10	S5597_225_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	226	0		29	10	S5597_226_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	226	0		29	10	S5597_226_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	226	0		29	10	S5597_226_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	226	0		29	10	S5597_226_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	226	0		29	10	S5597_226_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	226	0		29	10	S5597_226_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	226	0		29	10	S5597_226_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	226	0		29	10	S5597_226_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	227	0		29	10	S5597_227_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	227	0		29	10	S5597_227_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	227	0		29	10	S5597_227_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	227	0		29	10	S5597_227_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	227	0		29	10	S5597_227_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	227	0		29	10	S5597_227_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	227	0		29	10	S5597_227_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	227	0		29	10	S5597_227_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	228	0		29	10	S5597_228_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	228	0		29	10	S5597_228_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	228	0		29	10	S5597_228_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5597	228	0		29	10	S5597_228_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	228	0		29	10	S5597_228_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	228	0		29	10	S5597_228_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	228	0		29	10	S5597_228_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	228	0		29	10	S5597_228_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	229	0		29	10	S5597_229_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5597	229	0		29	10	S5597_229_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5597	229	0		29	10	S5597_229_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5597	229	0		29	10	S5597_229_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5597	229	0		29	10	S5597_229_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5597	229	0		29	10	S5597_229_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5597	229	0		29	10	S5597_229_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5597	229	0		29	10	S5597_229_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5601	002	0		29	10	S5601_002_0	4	3	1	biologics	010010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	002	0		29	10	S5601_002_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	002	0		29	10	S5601_002_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				33.00	99.00	66.00	33.00	99.00	66.00	38.00			22.00	66.00	44.00								2
S5601	003	0		29	10	S5601_003_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	003	0		29	10	S5601_003_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	003	0		29	10	S5601_003_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	003	0		29	10	S5601_003_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	004	0		29	10	S5601_004_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	004	0		29	10	S5601_004_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				35.00	105.00	70.00	35.00	105.00	70.00	40.00			24.00	70.00	47.00								2
S5601	004	0		29	10	S5601_004_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	005	0		29	10	S5601_005_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	005	0		29	10	S5601_005_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	005	0		29	10	S5601_005_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	005	0		29	10	S5601_005_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	006	0		29	10	S5601_006_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	006	0		29	10	S5601_006_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	006	0		29	10	S5601_006_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				35.00	105.00	70.00	35.00	105.00	70.00	40.00			24.00	70.00	47.00								2
S5601	007	0		29	10	S5601_007_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	007	0		29	10	S5601_007_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	007	0		29	10	S5601_007_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	007	0		29	10	S5601_007_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	008	0		29	10	S5601_008_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	008	0		29	10	S5601_008_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	008	0		29	10	S5601_008_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				39.00	117.00	78.00	39.00	117.00	78.00	44.00			26.00	78.00	52.00								2
S5601	009	0		29	10	S5601_009_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	009	0		29	10	S5601_009_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	009	0		29	10	S5601_009_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	009	0		29	10	S5601_009_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	010	0		29	10	S5601_010_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	010	0		29	10	S5601_010_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				37.00	111.00	74.00	37.00	111.00	74.00	42.00			25.00	74.00	50.00								2
S5601	010	0		29	10	S5601_010_0	4	3	1	biologics	010010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	011	0		29	10	S5601_011_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	011	0		29	10	S5601_011_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	011	0		29	10	S5601_011_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	011	0		29	10	S5601_011_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	012	0		29	10	S5601_012_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	012	0		29	10	S5601_012_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				37.00	111.00	74.00	37.00	111.00	74.00	42.00			25.00	74.00	50.00								2
S5601	012	0		29	10	S5601_012_0	4	3	1	biologics	010010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	013	0		29	10	S5601_013_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	013	0		29	10	S5601_013_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	013	0		29	10	S5601_013_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	013	0		29	10	S5601_013_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	014	0		29	10	S5601_014_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	014	0		29	10	S5601_014_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				37.00	111.00	74.00	37.00	111.00	74.00	42.00			25.00	74.00	50.00								2
S5601	014	0		29	10	S5601_014_0	4	3	1	biologics	010010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	015	0		29	10	S5601_015_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	015	0		29	10	S5601_015_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	015	0		29	10	S5601_015_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	015	0		29	10	S5601_015_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	016	0		29	10	S5601_016_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	016	0		29	10	S5601_016_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				39.00	117.00	78.00	39.00	117.00	78.00	44.00			26.00	78.00	52.00								2
S5601	016	0		29	10	S5601_016_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	017	0		29	10	S5601_017_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	017	0		29	10	S5601_017_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	017	0		29	10	S5601_017_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	017	0		29	10	S5601_017_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	018	0		29	10	S5601_018_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	018	0		29	10	S5601_018_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				39.00	117.00	78.00	39.00	117.00	78.00	44.00			26.00	78.00	52.00								2
S5601	018	0		29	10	S5601_018_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	019	0		29	10	S5601_019_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	019	0		29	10	S5601_019_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	019	0		29	10	S5601_019_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	019	0		29	10	S5601_019_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	020	0		29	10	S5601_020_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				39.00	117.00	78.00	39.00	117.00	78.00	44.00			26.00	78.00	52.00								2
S5601	020	0		29	10	S5601_020_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	020	0		29	10	S5601_020_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	021	0		29	10	S5601_021_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	021	0		29	10	S5601_021_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	021	0		29	10	S5601_021_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	021	0		29	10	S5601_021_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	022	0		29	10	S5601_022_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				36.00	108.00	72.00	36.00	108.00	72.00	41.00			24.00	72.00	48.00								2
S5601	022	0		29	10	S5601_022_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	022	0		29	10	S5601_022_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	023	0		29	10	S5601_023_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	023	0		29	10	S5601_023_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	023	0		29	10	S5601_023_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	023	0		29	10	S5601_023_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	024	0		29	10	S5601_024_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				39.00	117.00	78.00	39.00	117.00	78.00	44.00			26.00	78.00	52.00								2
S5601	024	0		29	10	S5601_024_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	024	0		29	10	S5601_024_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	025	0		29	10	S5601_025_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	025	0		29	10	S5601_025_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	025	0		29	10	S5601_025_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	025	0		29	10	S5601_025_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	026	0		29	10	S5601_026_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	026	0		29	10	S5601_026_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				37.00	111.00	74.00	37.00	111.00	74.00	42.00			25.00	74.00	50.00								2
S5601	026	0		29	10	S5601_026_0	4	3	1	biologics	010010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	027	0		29	10	S5601_027_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	027	0		29	10	S5601_027_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	027	0		29	10	S5601_027_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	027	0		29	10	S5601_027_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	028	0		29	10	S5601_028_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	028	0		29	10	S5601_028_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				39.00	117.00	78.00	39.00	117.00	78.00	44.00			26.00	78.00	52.00								2
S5601	028	0		29	10	S5601_028_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	029	0		29	10	S5601_029_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	029	0		29	10	S5601_029_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	029	0		29	10	S5601_029_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	029	0		29	10	S5601_029_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	030	0		29	10	S5601_030_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	030	0		29	10	S5601_030_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				39.00	117.00	78.00	39.00	117.00	78.00	44.00			26.00	78.00	52.00								2
S5601	030	0		29	10	S5601_030_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	031	0		29	10	S5601_031_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	031	0		29	10	S5601_031_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	031	0		29	10	S5601_031_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	031	0		29	10	S5601_031_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	032	0		29	10	S5601_032_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	032	0		29	10	S5601_032_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				31.00	93.00	62.00	31.00	93.00	62.00	36.00			21.00	62.00	42.00								2
S5601	032	0		29	10	S5601_032_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	033	0		29	10	S5601_033_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	033	0		29	10	S5601_033_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	033	0		29	10	S5601_033_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	033	0		29	10	S5601_033_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	034	0		29	10	S5601_034_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	034	0		29	10	S5601_034_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				33.00	99.00	66.00	33.00	99.00	66.00	38.00			22.00	66.00	44.00								2
S5601	034	0		29	10	S5601_034_0	4	3	1	biologics	010010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	035	0		29	10	S5601_035_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	035	0		29	10	S5601_035_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	035	0		29	10	S5601_035_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	035	0		29	10	S5601_035_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	036	0		29	10	S5601_036_0	4	3	1	biologics	010010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	036	0		29	10	S5601_036_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				37.00	111.00	74.00	37.00	111.00	74.00	42.00			25.00	74.00	50.00								2
S5601	036	0		29	10	S5601_036_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	037	0		29	10	S5601_037_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	037	0		29	10	S5601_037_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	037	0		29	10	S5601_037_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	037	0		29	10	S5601_037_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	038	0		29	10	S5601_038_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	038	0		29	10	S5601_038_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				31.00	93.00	62.00	31.00	93.00	62.00	36.00			21.00	62.00	42.00								2
S5601	038	0		29	10	S5601_038_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	039	0		29	10	S5601_039_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	039	0		29	10	S5601_039_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	039	0		29	10	S5601_039_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	039	0		29	10	S5601_039_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	040	0		29	10	S5601_040_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	040	0		29	10	S5601_040_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				35.00	105.00	70.00	35.00	105.00	70.00	40.00			24.00	70.00	47.00								2
S5601	040	0		29	10	S5601_040_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	041	0		29	10	S5601_041_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	041	0		29	10	S5601_041_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	041	0		29	10	S5601_041_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	041	0		29	10	S5601_041_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	042	0		29	10	S5601_042_0	4	3	1	biologics	010010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	042	0		29	10	S5601_042_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				37.00	111.00	74.00	37.00	111.00	74.00	42.00			25.00	74.00	50.00								2
S5601	042	0		29	10	S5601_042_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	043	0		29	10	S5601_043_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	043	0		29	10	S5601_043_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	043	0		29	10	S5601_043_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	043	0		29	10	S5601_043_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	044	0		29	10	S5601_044_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	044	0		29	10	S5601_044_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				36.00	108.00	72.00	36.00	108.00	72.00	41.00			24.00	72.00	48.00								2
S5601	044	0		29	10	S5601_044_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	045	0		29	10	S5601_045_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	045	0		29	10	S5601_045_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	045	0		29	10	S5601_045_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	045	0		29	10	S5601_045_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	046	0		29	10	S5601_046_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	046	0		29	10	S5601_046_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	046	0		29	10	S5601_046_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				36.00	108.00	72.00	36.00	108.00	72.00	41.00			24.00	72.00	48.00								2
S5601	047	0		29	10	S5601_047_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	047	0		29	10	S5601_047_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	047	0		29	10	S5601_047_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	047	0		29	10	S5601_047_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	048	0		29	10	S5601_048_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	048	0		29	10	S5601_048_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	048	0		29	10	S5601_048_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				35.00	105.00	70.00	35.00	105.00	70.00	40.00			24.00	70.00	47.00								2
S5601	049	0		29	10	S5601_049_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	049	0		29	10	S5601_049_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	049	0		29	10	S5601_049_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	049	0		29	10	S5601_049_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	050	0		29	10	S5601_050_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	050	0		29	10	S5601_050_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				30.00	90.00	60.00	30.00	90.00	60.00	35.00			20.00	60.00	40.00								2
S5601	050	0		29	10	S5601_050_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	051	0		29	10	S5601_051_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	051	0		29	10	S5601_051_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	051	0		29	10	S5601_051_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	051	0		29	10	S5601_051_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	052	0		29	10	S5601_052_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	052	0		29	10	S5601_052_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				29.00	87.00	58.00	29.00	87.00	58.00	34.00			20.00	58.00	39.00								2
S5601	052	0		29	10	S5601_052_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	053	0		29	10	S5601_053_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	053	0		29	10	S5601_053_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	053	0		29	10	S5601_053_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	053	0		29	10	S5601_053_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	054	0		29	10	S5601_054_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	054	0		29	10	S5601_054_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				29.00	87.00	58.00	29.00	87.00	58.00	34.00			20.00	58.00	39.00								2
S5601	054	0		29	10	S5601_054_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	055	0		29	10	S5601_055_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	055	0		29	10	S5601_055_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	055	0		29	10	S5601_055_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	055	0		29	10	S5601_055_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	056	0		29	10	S5601_056_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	056	0		29	10	S5601_056_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				29.00	87.00	58.00	29.00	87.00	58.00	34.00			20.00	58.00	39.00								2
S5601	056	0		29	10	S5601_056_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	057	0		29	10	S5601_057_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	057	0		29	10	S5601_057_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	057	0		29	10	S5601_057_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	057	0		29	10	S5601_057_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	058	0		29	10	S5601_058_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	058	0		29	10	S5601_058_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	058	0		29	10	S5601_058_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				29.00	87.00	58.00	29.00	87.00	58.00	34.00			20.00	58.00	39.00								2
S5601	059	0		29	10	S5601_059_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	059	0		29	10	S5601_059_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	059	0		29	10	S5601_059_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	059	0		29	10	S5601_059_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	060	0		29	10	S5601_060_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	060	0		29	10	S5601_060_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				30.00	90.00	60.00	30.00	90.00	60.00	35.00			20.00	60.00	40.00								2
S5601	060	0		29	10	S5601_060_0	4	3	1	biologics	000010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	061	0		29	10	S5601_061_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	061	0		29	10	S5601_061_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	061	0		29	10	S5601_061_0	4	4	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	061	0		29	10	S5601_061_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
S5601	062	0		29	10	S5601_062_0	4	2	1	brand	000010		2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				33.00	99.00	66.00	33.00	99.00	66.00	38.00			22.00	66.00	44.00								2
S5601	062	0		29	10	S5601_062_0	4	1	1	generic	010000		2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								2
S5601	062	0		29	10	S5601_062_0	4	3	1	biologics	010010		1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				25			25			25												biologics																							2
S5601	063	0		29	10	S5601_063_0	4	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				10.00	30.00	20.00	10.00	30.00	20.00	15.00			6.00	18.00	12.00								4
S5601	063	0		29	10	S5601_063_0	4	2	1	preferred brand	000001	1	2	preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							preferred brand	1	2		000011111110011100000	preferred brand																						preferred brand				25.00	75.00	50.00	25.00	75.00	50.00	30.00			20.00	60.00	40.00								4
S5601	063	0		29	10	S5601_063_0	4	3	1	non-preferred brand	100000	1	2	non-preferred brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							non-preferred brand	1	2		000011111110011100000	non-preferred brand																						non-preferred brand				70.00	210.00	140.00	70.00	210.00	140.00	75.00			64.00	192.00	128.00								4
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S5601	103	0		29	10	S5601_103_0	5	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								4
S5601	103	0		29	10	S5601_103_0	5	1	3	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00							1	4
S5601	103	0		29	10	S5601_103_0	5	2	3	brand	000010	1	2	brand																							brand					brand																						brand																						2	4
S5601	104	0		29	10	S5601_104_0	5	3	3	biologics	010010	1	1	biologics																							biologics					biologics																						biologics																						2	4
S5601	104	0		29	10	S5601_104_0	5	2	3	brand	000010	1	2	brand																							brand					brand																						brand																						2	4
S5601	104	0		29	10	S5601_104_0	5	1	3	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00							1	4
S5601	104	0		29	10	S5601_104_0	5	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								4
S5601	104	0		29	10	S5601_104_0	5	2	1	brand	000010	1	2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				40.00	120.00	80.00	40.00	120.00	80.00	45.00			29.00	87.00	58.00								4
S5601	104	0		29	10	S5601_104_0	5	3	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	105	0		29	10	S5601_105_0	5	3	3	biologics	010010	1	1	biologics																							biologics					biologics																						biologics																						2	4
S5601	105	0		29	10	S5601_105_0	5	2	3	brand	000010	1	2	brand																							brand					brand																						brand																						2	4
S5601	105	0		29	10	S5601_105_0	5	1	3	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00							1	4
S5601	105	0		29	10	S5601_105_0	5	2	1	brand	000010	1	2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				40.00	120.00	80.00	40.00	120.00	80.00	45.00			29.00	87.00	58.00								4
S5601	105	0		29	10	S5601_105_0	5	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								4
S5601	105	0		29	10	S5601_105_0	5	3	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5601	106	0		29	10	S5601_106_0	5	1	3	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00							1	4
S5601	106	0		29	10	S5601_106_0	5	2	3	brand	000010	1	2	brand																							brand					brand																						brand																						2	4
S5601	106	0		29	10	S5601_106_0	5	2	1	brand	000010	1	2	brand	000011111110011100000				34	90	60	34	90	60	34			34	90	60							brand	1	2		000011111110011100000	brand																						brand				37.00	111.00	74.00	37.00	111.00	74.00	42.00			29.00	87.00	58.00								4
S5601	106	0		29	10	S5601_106_0	5	1	1	generic	010000	1	2	generic	000011111110011100000				34	90	60	34	90	60	34			34	90	60							generic	1	2		000011111110011100000	generic																						generic				5.00	15.00	10.00	5.00	15.00	10.00	10.00			4.00	10.00	7.00								4
S5601	106	0		29	10	S5601_106_0	5	3	3	biologics	010010	1	1	biologics																							biologics					biologics																						biologics																						2	4
S5601	106	0		29	10	S5601_106_0	5	3	1	biologics	010010	1	1	biologics	000010010010000000000				34			34			34												biologics	1	1	000010010010000000000		biologics				33			33			33												biologics																							4
S5609	001	0		29	10	S5609_001_0	3	4	1	Specialty	110001		1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							2
S5609	001	0		29	10	S5609_001_0	3	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	105.00		35.00			35.00			105.00	105.00									2
S5609	001	0		29	10	S5609_001_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				18.00	54.00		18.00			18.00			54.00	54.00									2
S5609	001	0		29	10	S5609_001_0	3	1	1	Generic	010000		2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									2
S5609	001	0		29	10	S5609_001_0	3	5	1	Miscellaneous Injectable	110001		2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							2
S5609	002	0		29	10	S5609_002_0	4	1	3	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00								1	4
S5609	002	0		29	10	S5609_002_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5609	002	0		29	10	S5609_002_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5609	002	0		29	10	S5609_002_0	4	4	3	Specialty	110001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5609	002	0		29	10	S5609_002_0	4	5	1	Miscellaneous Injectable	110001	1	2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							4
S5609	002	0		29	10	S5609_002_0	4	4	1	Specialty	110001	1	1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							4
S5609	002	0		29	10	S5609_002_0	4	5	3	Miscellaneous Injectable	110001	1	2	Miscellaneous Injectable																							Miscellaneous Injectable					Miscellaneous Injectable																						Miscellaneous Injectable																						2	4
S5609	002	0		29	10	S5609_002_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00			25.00			75.00	75.00									4
S5609	002	0		29	10	S5609_002_0	4	1	1	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									4
S5609	002	0		29	10	S5609_002_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	150.00		50.00			50.00			150.00	150.00									4
S5617	003	0		29	10	S5617_003_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	003	0		29	10	S5617_003_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	003	0		29	10	S5617_003_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	003	0		29	10	S5617_003_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	005	0		29	10	S5617_005_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	005	0		29	10	S5617_005_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	005	0		29	10	S5617_005_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	005	0		29	10	S5617_005_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	008	0		29	10	S5617_008_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	008	0		29	10	S5617_008_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	008	0		29	10	S5617_008_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	008	0		29	10	S5617_008_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	010	0		29	10	S5617_010_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	010	0		29	10	S5617_010_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	010	0		29	10	S5617_010_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	010	0		29	10	S5617_010_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	013	0		29	10	S5617_013_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	013	0		29	10	S5617_013_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	013	0		29	10	S5617_013_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	013	0		29	10	S5617_013_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	015	0		29	10	S5617_015_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	015	0		29	10	S5617_015_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	015	0		29	10	S5617_015_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	015	0		29	10	S5617_015_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	018	0		29	10	S5617_018_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	018	0		29	10	S5617_018_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	018	0		29	10	S5617_018_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	018	0		29	10	S5617_018_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	020	0		29	10	S5617_020_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	020	0		29	10	S5617_020_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	020	0		29	10	S5617_020_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	020	0		29	10	S5617_020_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	023	0		29	10	S5617_023_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	023	0		29	10	S5617_023_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	023	0		29	10	S5617_023_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	023	0		29	10	S5617_023_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	025	0		29	10	S5617_025_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	025	0		29	10	S5617_025_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	025	0		29	10	S5617_025_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	025	0		29	10	S5617_025_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	028	0		29	10	S5617_028_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	028	0		29	10	S5617_028_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	028	0		29	10	S5617_028_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	028	0		29	10	S5617_028_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	030	0		29	10	S5617_030_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	030	0		29	10	S5617_030_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	030	0		29	10	S5617_030_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	030	0		29	10	S5617_030_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	033	0		29	10	S5617_033_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	033	0		29	10	S5617_033_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	033	0		29	10	S5617_033_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	033	0		29	10	S5617_033_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	035	0		29	10	S5617_035_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	035	0		29	10	S5617_035_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	035	0		29	10	S5617_035_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	035	0		29	10	S5617_035_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	038	0		29	10	S5617_038_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	038	0		29	10	S5617_038_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	038	0		29	10	S5617_038_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	038	0		29	10	S5617_038_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	040	0		29	10	S5617_040_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	040	0		29	10	S5617_040_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	040	0		29	10	S5617_040_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	040	0		29	10	S5617_040_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	043	0		29	10	S5617_043_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	043	0		29	10	S5617_043_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	043	0		29	10	S5617_043_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	043	0		29	10	S5617_043_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	045	0		29	10	S5617_045_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	045	0		29	10	S5617_045_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	045	0		29	10	S5617_045_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	045	0		29	10	S5617_045_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	048	0		29	10	S5617_048_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	048	0		29	10	S5617_048_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	048	0		29	10	S5617_048_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	048	0		29	10	S5617_048_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	050	0		29	10	S5617_050_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	050	0		29	10	S5617_050_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	050	0		29	10	S5617_050_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	050	0		29	10	S5617_050_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	053	0		29	10	S5617_053_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	053	0		29	10	S5617_053_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	053	0		29	10	S5617_053_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	053	0		29	10	S5617_053_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	055	0		29	10	S5617_055_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	055	0		29	10	S5617_055_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	055	0		29	10	S5617_055_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	055	0		29	10	S5617_055_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	058	0		29	10	S5617_058_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	058	0		29	10	S5617_058_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	058	0		29	10	S5617_058_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	058	0		29	10	S5617_058_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	060	0		29	10	S5617_060_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	060	0		29	10	S5617_060_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	060	0		29	10	S5617_060_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	060	0		29	10	S5617_060_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	063	0		29	10	S5617_063_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	063	0		29	10	S5617_063_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	063	0		29	10	S5617_063_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	063	0		29	10	S5617_063_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	065	0		29	10	S5617_065_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	065	0		29	10	S5617_065_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	065	0		29	10	S5617_065_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	065	0		29	10	S5617_065_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	068	0		29	10	S5617_068_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	068	0		29	10	S5617_068_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	068	0		29	10	S5617_068_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	068	0		29	10	S5617_068_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	070	0		29	10	S5617_070_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	070	0		29	10	S5617_070_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	070	0		29	10	S5617_070_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	070	0		29	10	S5617_070_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	073	0		29	10	S5617_073_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	073	0		29	10	S5617_073_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	073	0		29	10	S5617_073_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	073	0		29	10	S5617_073_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	075	0		29	10	S5617_075_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	075	0		29	10	S5617_075_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	075	0		29	10	S5617_075_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	075	0		29	10	S5617_075_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	078	0		29	10	S5617_078_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	078	0		29	10	S5617_078_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	078	0		29	10	S5617_078_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	078	0		29	10	S5617_078_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	080	0		29	10	S5617_080_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	080	0		29	10	S5617_080_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	080	0		29	10	S5617_080_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	080	0		29	10	S5617_080_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	083	0		29	10	S5617_083_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	083	0		29	10	S5617_083_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	083	0		29	10	S5617_083_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	083	0		29	10	S5617_083_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	085	0		29	10	S5617_085_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	085	0		29	10	S5617_085_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	085	0		29	10	S5617_085_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	085	0		29	10	S5617_085_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	088	0		29	10	S5617_088_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	088	0		29	10	S5617_088_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	088	0		29	10	S5617_088_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	088	0		29	10	S5617_088_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	090	0		29	10	S5617_090_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	090	0		29	10	S5617_090_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	090	0		29	10	S5617_090_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	090	0		29	10	S5617_090_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	093	0		29	10	S5617_093_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	093	0		29	10	S5617_093_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	093	0		29	10	S5617_093_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	093	0		29	10	S5617_093_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	095	0		29	10	S5617_095_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	095	0		29	10	S5617_095_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	095	0		29	10	S5617_095_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	095	0		29	10	S5617_095_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	098	0		29	10	S5617_098_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	098	0		29	10	S5617_098_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	098	0		29	10	S5617_098_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	098	0		29	10	S5617_098_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	100	0		29	10	S5617_100_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	100	0		29	10	S5617_100_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	100	0		29	10	S5617_100_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	100	0		29	10	S5617_100_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	103	0		29	10	S5617_103_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	103	0		29	10	S5617_103_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	103	0		29	10	S5617_103_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	103	0		29	10	S5617_103_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	105	0		29	10	S5617_105_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	105	0		29	10	S5617_105_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	105	0		29	10	S5617_105_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	105	0		29	10	S5617_105_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	108	0		29	10	S5617_108_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	108	0		29	10	S5617_108_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	108	0		29	10	S5617_108_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	108	0		29	10	S5617_108_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	110	0		29	10	S5617_110_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	110	0		29	10	S5617_110_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	110	0		29	10	S5617_110_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	110	0		29	10	S5617_110_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	113	0		29	10	S5617_113_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	113	0		29	10	S5617_113_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	113	0		29	10	S5617_113_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	113	0		29	10	S5617_113_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	115	0		29	10	S5617_115_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	115	0		29	10	S5617_115_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	115	0		29	10	S5617_115_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	115	0		29	10	S5617_115_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	118	0		29	10	S5617_118_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	118	0		29	10	S5617_118_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	118	0		29	10	S5617_118_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	118	0		29	10	S5617_118_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	120	0		29	10	S5617_120_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	120	0		29	10	S5617_120_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	120	0		29	10	S5617_120_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	120	0		29	10	S5617_120_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	123	0		29	10	S5617_123_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	123	0		29	10	S5617_123_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	123	0		29	10	S5617_123_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	123	0		29	10	S5617_123_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	125	0		29	10	S5617_125_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	125	0		29	10	S5617_125_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	125	0		29	10	S5617_125_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	125	0		29	10	S5617_125_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	128	0		29	10	S5617_128_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	128	0		29	10	S5617_128_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	128	0		29	10	S5617_128_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	128	0		29	10	S5617_128_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	130	0		29	10	S5617_130_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	130	0		29	10	S5617_130_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	130	0		29	10	S5617_130_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	130	0		29	10	S5617_130_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	133	0		29	10	S5617_133_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	133	0		29	10	S5617_133_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	133	0		29	10	S5617_133_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	133	0		29	10	S5617_133_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	135	0		29	10	S5617_135_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	135	0		29	10	S5617_135_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	135	0		29	10	S5617_135_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	135	0		29	10	S5617_135_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	138	0		29	10	S5617_138_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	138	0		29	10	S5617_138_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	138	0		29	10	S5617_138_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	138	0		29	10	S5617_138_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	140	0		29	10	S5617_140_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	140	0		29	10	S5617_140_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	140	0		29	10	S5617_140_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	140	0		29	10	S5617_140_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	143	0		29	10	S5617_143_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	143	0		29	10	S5617_143_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	143	0		29	10	S5617_143_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	143	0		29	10	S5617_143_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	145	0		29	10	S5617_145_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	145	0		29	10	S5617_145_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	145	0		29	10	S5617_145_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	145	0		29	10	S5617_145_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	148	0		29	10	S5617_148_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	148	0		29	10	S5617_148_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	148	0		29	10	S5617_148_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	148	0		29	10	S5617_148_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	150	0		29	10	S5617_150_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	150	0		29	10	S5617_150_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	150	0		29	10	S5617_150_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	150	0		29	10	S5617_150_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	153	0		29	10	S5617_153_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	153	0		29	10	S5617_153_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	153	0		29	10	S5617_153_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	153	0		29	10	S5617_153_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	155	0		29	10	S5617_155_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	155	0		29	10	S5617_155_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	155	0		29	10	S5617_155_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	155	0		29	10	S5617_155_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	158	0		29	10	S5617_158_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	158	0		29	10	S5617_158_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	158	0		29	10	S5617_158_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	158	0		29	10	S5617_158_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	160	0		29	10	S5617_160_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	160	0		29	10	S5617_160_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	160	0		29	10	S5617_160_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	160	0		29	10	S5617_160_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	163	0		29	10	S5617_163_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	163	0		29	10	S5617_163_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	163	0		29	10	S5617_163_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	163	0		29	10	S5617_163_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	165	0		29	10	S5617_165_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	165	0		29	10	S5617_165_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	165	0		29	10	S5617_165_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	165	0		29	10	S5617_165_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	168	0		29	10	S5617_168_0	6	1	1	Generic	010000		2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	0.00	0.00								0.00						0.00	0.00			25.00			3
S5617	168	0		29	10	S5617_168_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	20.00	60.00								20.00						20.00	50.00			60.00			3
S5617	168	0		29	10	S5617_168_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00						60.00	150.00			180.00			3
S5617	168	0		29	10	S5617_168_0	6	4	1	Specialty	000010		1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							3
S5617	170	0		29	10	S5617_170_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								10						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	170	0		29	10	S5617_170_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	170	0		29	10	S5617_170_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	170	0		29	10	S5617_170_0	4	1	1	Generic	010000	1	2	Generic	011000000010000011000	30	90								10						30	90					Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	171	0		29	10	S5617_171_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	171	0		29	10	S5617_171_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	171	0		29	10	S5617_171_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	171	0		29	10	S5617_171_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	171	0		29	10	S5617_171_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	171	0		29	10	S5617_171_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	171	0		29	10	S5617_171_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	171	0		29	10	S5617_171_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	172	0		29	10	S5617_172_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	172	0		29	10	S5617_172_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	172	0		29	10	S5617_172_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	172	0		29	10	S5617_172_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	172	0		29	10	S5617_172_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	172	0		29	10	S5617_172_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	172	0		29	10	S5617_172_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	172	0		29	10	S5617_172_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	173	0		29	10	S5617_173_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	173	0		29	10	S5617_173_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	173	0		29	10	S5617_173_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	173	0		29	10	S5617_173_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	173	0		29	10	S5617_173_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	173	0		29	10	S5617_173_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	173	0		29	10	S5617_173_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	173	0		29	10	S5617_173_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	174	0		29	10	S5617_174_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	174	0		29	10	S5617_174_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	174	0		29	10	S5617_174_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	174	0		29	10	S5617_174_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	174	0		29	10	S5617_174_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	174	0		29	10	S5617_174_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	174	0		29	10	S5617_174_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	174	0		29	10	S5617_174_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	175	0		29	10	S5617_175_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	175	0		29	10	S5617_175_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	175	0		29	10	S5617_175_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	175	0		29	10	S5617_175_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	175	0		29	10	S5617_175_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	175	0		29	10	S5617_175_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	175	0		29	10	S5617_175_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	175	0		29	10	S5617_175_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	176	0		29	10	S5617_176_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	176	0		29	10	S5617_176_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	176	0		29	10	S5617_176_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	176	0		29	10	S5617_176_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	176	0		29	10	S5617_176_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	176	0		29	10	S5617_176_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	176	0		29	10	S5617_176_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	176	0		29	10	S5617_176_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	177	0		29	10	S5617_177_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	177	0		29	10	S5617_177_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	177	0		29	10	S5617_177_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	177	0		29	10	S5617_177_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	177	0		29	10	S5617_177_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	177	0		29	10	S5617_177_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	177	0		29	10	S5617_177_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	177	0		29	10	S5617_177_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	178	0		29	10	S5617_178_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	178	0		29	10	S5617_178_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	178	0		29	10	S5617_178_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	178	0		29	10	S5617_178_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	178	0		29	10	S5617_178_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	178	0		29	10	S5617_178_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	178	0		29	10	S5617_178_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	178	0		29	10	S5617_178_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	179	0		29	10	S5617_179_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	179	0		29	10	S5617_179_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	179	0		29	10	S5617_179_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	179	0		29	10	S5617_179_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	179	0		29	10	S5617_179_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	179	0		29	10	S5617_179_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	179	0		29	10	S5617_179_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	179	0		29	10	S5617_179_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	180	0		29	10	S5617_180_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	180	0		29	10	S5617_180_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	180	0		29	10	S5617_180_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	180	0		29	10	S5617_180_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	180	0		29	10	S5617_180_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	180	0		29	10	S5617_180_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	180	0		29	10	S5617_180_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	180	0		29	10	S5617_180_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	181	0		29	10	S5617_181_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	181	0		29	10	S5617_181_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	181	0		29	10	S5617_181_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	181	0		29	10	S5617_181_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	181	0		29	10	S5617_181_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	181	0		29	10	S5617_181_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	181	0		29	10	S5617_181_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	181	0		29	10	S5617_181_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	182	0		29	10	S5617_182_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	182	0		29	10	S5617_182_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	182	0		29	10	S5617_182_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	182	0		29	10	S5617_182_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	182	0		29	10	S5617_182_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	182	0		29	10	S5617_182_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	182	0		29	10	S5617_182_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	182	0		29	10	S5617_182_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	183	0		29	10	S5617_183_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	183	0		29	10	S5617_183_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	183	0		29	10	S5617_183_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	183	0		29	10	S5617_183_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	183	0		29	10	S5617_183_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	183	0		29	10	S5617_183_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	183	0		29	10	S5617_183_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	183	0		29	10	S5617_183_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	184	0		29	10	S5617_184_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	184	0		29	10	S5617_184_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	184	0		29	10	S5617_184_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	184	0		29	10	S5617_184_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	184	0		29	10	S5617_184_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	184	0		29	10	S5617_184_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	184	0		29	10	S5617_184_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	184	0		29	10	S5617_184_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	185	0		29	10	S5617_185_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	185	0		29	10	S5617_185_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	185	0		29	10	S5617_185_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	185	0		29	10	S5617_185_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	185	0		29	10	S5617_185_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	185	0		29	10	S5617_185_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	185	0		29	10	S5617_185_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	185	0		29	10	S5617_185_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	186	0		29	10	S5617_186_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	186	0		29	10	S5617_186_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	186	0		29	10	S5617_186_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	186	0		29	10	S5617_186_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	186	0		29	10	S5617_186_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	186	0		29	10	S5617_186_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	186	0		29	10	S5617_186_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	186	0		29	10	S5617_186_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	187	0		29	10	S5617_187_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	187	0		29	10	S5617_187_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	187	0		29	10	S5617_187_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	187	0		29	10	S5617_187_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	187	0		29	10	S5617_187_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	187	0		29	10	S5617_187_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	187	0		29	10	S5617_187_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	187	0		29	10	S5617_187_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	188	0		29	10	S5617_188_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	188	0		29	10	S5617_188_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	188	0		29	10	S5617_188_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	188	0		29	10	S5617_188_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	188	0		29	10	S5617_188_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	188	0		29	10	S5617_188_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	188	0		29	10	S5617_188_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	188	0		29	10	S5617_188_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	189	0		29	10	S5617_189_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	189	0		29	10	S5617_189_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	189	0		29	10	S5617_189_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	189	0		29	10	S5617_189_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	189	0		29	10	S5617_189_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	189	0		29	10	S5617_189_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	189	0		29	10	S5617_189_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	189	0		29	10	S5617_189_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	190	0		29	10	S5617_190_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	190	0		29	10	S5617_190_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	190	0		29	10	S5617_190_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	190	0		29	10	S5617_190_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	190	0		29	10	S5617_190_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	190	0		29	10	S5617_190_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	190	0		29	10	S5617_190_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	190	0		29	10	S5617_190_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	191	0		29	10	S5617_191_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	191	0		29	10	S5617_191_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	191	0		29	10	S5617_191_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	191	0		29	10	S5617_191_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	191	0		29	10	S5617_191_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	191	0		29	10	S5617_191_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	191	0		29	10	S5617_191_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	191	0		29	10	S5617_191_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	192	0		29	10	S5617_192_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	192	0		29	10	S5617_192_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	192	0		29	10	S5617_192_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	192	0		29	10	S5617_192_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	192	0		29	10	S5617_192_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	192	0		29	10	S5617_192_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	192	0		29	10	S5617_192_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	192	0		29	10	S5617_192_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	193	0		29	10	S5617_193_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	193	0		29	10	S5617_193_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	193	0		29	10	S5617_193_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	193	0		29	10	S5617_193_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	193	0		29	10	S5617_193_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	193	0		29	10	S5617_193_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	193	0		29	10	S5617_193_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	193	0		29	10	S5617_193_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	194	0		29	10	S5617_194_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	194	0		29	10	S5617_194_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	194	0		29	10	S5617_194_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	194	0		29	10	S5617_194_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	194	0		29	10	S5617_194_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	194	0		29	10	S5617_194_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	194	0		29	10	S5617_194_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	194	0		29	10	S5617_194_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	195	0		29	10	S5617_195_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	195	0		29	10	S5617_195_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	195	0		29	10	S5617_195_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	195	0		29	10	S5617_195_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	195	0		29	10	S5617_195_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	195	0		29	10	S5617_195_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	195	0		29	10	S5617_195_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	195	0		29	10	S5617_195_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	196	0		29	10	S5617_196_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	196	0		29	10	S5617_196_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	196	0		29	10	S5617_196_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	196	0		29	10	S5617_196_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	196	0		29	10	S5617_196_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	196	0		29	10	S5617_196_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	196	0		29	10	S5617_196_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	196	0		29	10	S5617_196_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	197	0		29	10	S5617_197_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	197	0		29	10	S5617_197_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	197	0		29	10	S5617_197_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	197	0		29	10	S5617_197_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	197	0		29	10	S5617_197_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	197	0		29	10	S5617_197_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	197	0		29	10	S5617_197_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	197	0		29	10	S5617_197_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	198	0		29	10	S5617_198_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	198	0		29	10	S5617_198_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	198	0		29	10	S5617_198_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	198	0		29	10	S5617_198_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	198	0		29	10	S5617_198_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	198	0		29	10	S5617_198_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	198	0		29	10	S5617_198_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	198	0		29	10	S5617_198_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	199	0		29	10	S5617_199_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	199	0		29	10	S5617_199_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	199	0		29	10	S5617_199_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	199	0		29	10	S5617_199_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	199	0		29	10	S5617_199_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	199	0		29	10	S5617_199_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	199	0		29	10	S5617_199_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	199	0		29	10	S5617_199_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	200	0		29	10	S5617_200_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	200	0		29	10	S5617_200_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	200	0		29	10	S5617_200_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	200	0		29	10	S5617_200_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	200	0		29	10	S5617_200_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	200	0		29	10	S5617_200_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	200	0		29	10	S5617_200_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	200	0		29	10	S5617_200_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	201	0		29	10	S5617_201_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	201	0		29	10	S5617_201_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	201	0		29	10	S5617_201_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	201	0		29	10	S5617_201_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	201	0		29	10	S5617_201_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	201	0		29	10	S5617_201_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	201	0		29	10	S5617_201_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	201	0		29	10	S5617_201_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	202	0		29	10	S5617_202_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	202	0		29	10	S5617_202_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	202	0		29	10	S5617_202_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	202	0		29	10	S5617_202_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	202	0		29	10	S5617_202_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	202	0		29	10	S5617_202_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	202	0		29	10	S5617_202_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	202	0		29	10	S5617_202_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	203	0		29	10	S5617_203_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	203	0		29	10	S5617_203_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5617	203	0		29	10	S5617_203_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	203	0		29	10	S5617_203_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	203	0		29	10	S5617_203_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	203	0		29	10	S5617_203_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	203	0		29	10	S5617_203_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	203	0		29	10	S5617_203_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	204	0		29	10	S5617_204_0	3	1	1	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00			4
S5617	204	0		29	10	S5617_204_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000011001	30	90								10						30	90			90		Preferred Brand	2	2		011000000010000011001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00						30.00	75.00			90.00			4
S5617	204	0		29	10	S5617_204_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000011001	30	90								10						30	90			90		Non-Preferred Brand	2	2		011000000010000011001	Non-Preferred Brand																						Non-Preferred Brand	50.00	150.00								50.00						50.00	125.00			150.00			4
S5617	204	0		29	10	S5617_204_0	3	4	1	Specialty	000010	1	1	Specialty	011000000010000011001	30	90								30						30	90			90		Specialty	2	1	011000000010000011001		Specialty	30	30								30						30	30			30		Specialty																							4
S5617	204	0		29	10	S5617_204_0	3	1	3	Generic	010000	1	2	Generic	011000000010000011001	30	90								10						30	90			90		Generic	2	2		011000000010000011001	Generic																						Generic	4.00	12.00								4.00						4.00	10.00			12.00		1	4
S5617	204	0		29	10	S5617_204_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5617	204	0		29	10	S5617_204_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5617	204	0		29	10	S5617_204_0	3	4	3	Specialty	000010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5644	004	0		29	10	S5644_004_0	6	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	004	0		29	10	S5644_004_0	6	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	004	0		29	10	S5644_004_0	6	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	005	0		29	10	S5644_005_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	005	0		29	10	S5644_005_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	005	0		29	10	S5644_005_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	012	0		29	10	S5644_012_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	012	0		29	10	S5644_012_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	012	0		29	10	S5644_012_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	045	0		29	10	S5644_045_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	045	0		29	10	S5644_045_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	045	0		29	10	S5644_045_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	045	0		29	10	S5644_045_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	047	0		29	10	S5644_047_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	047	0		29	10	S5644_047_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	047	0		29	10	S5644_047_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	047	0		29	10	S5644_047_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	048	0		29	10	S5644_048_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	048	0		29	10	S5644_048_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	048	0		29	10	S5644_048_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	048	0		29	10	S5644_048_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	049	0		29	10	S5644_049_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	049	0		29	10	S5644_049_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	049	0		29	10	S5644_049_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	049	0		29	10	S5644_049_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	050	0		29	10	S5644_050_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	050	0		29	10	S5644_050_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	050	0		29	10	S5644_050_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	050	0		29	10	S5644_050_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	051	0		29	10	S5644_051_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	051	0		29	10	S5644_051_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	051	0		29	10	S5644_051_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	051	0		29	10	S5644_051_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	052	0		29	10	S5644_052_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	052	0		29	10	S5644_052_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	052	0		29	10	S5644_052_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	052	0		29	10	S5644_052_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	053	0		29	10	S5644_053_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	053	0		29	10	S5644_053_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	053	0		29	10	S5644_053_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	053	0		29	10	S5644_053_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	054	0		29	10	S5644_054_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	054	0		29	10	S5644_054_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	054	0		29	10	S5644_054_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	054	0		29	10	S5644_054_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	055	0		29	10	S5644_055_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	055	0		29	10	S5644_055_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	055	0		29	10	S5644_055_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	055	0		29	10	S5644_055_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	056	0		29	10	S5644_056_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	056	0		29	10	S5644_056_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	056	0		29	10	S5644_056_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	056	0		29	10	S5644_056_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	057	0		29	10	S5644_057_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	057	0		29	10	S5644_057_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	057	0		29	10	S5644_057_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	057	0		29	10	S5644_057_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	058	0		29	10	S5644_058_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	058	0		29	10	S5644_058_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	058	0		29	10	S5644_058_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	058	0		29	10	S5644_058_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	059	0		29	10	S5644_059_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	059	0		29	10	S5644_059_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	059	0		29	10	S5644_059_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	059	0		29	10	S5644_059_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	060	0		29	10	S5644_060_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	060	0		29	10	S5644_060_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	060	0		29	10	S5644_060_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	060	0		29	10	S5644_060_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	061	0		29	10	S5644_061_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	061	0		29	10	S5644_061_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	061	0		29	10	S5644_061_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	061	0		29	10	S5644_061_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	062	0		29	10	S5644_062_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	062	0		29	10	S5644_062_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	062	0		29	10	S5644_062_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	062	0		29	10	S5644_062_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	063	0		29	10	S5644_063_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	063	0		29	10	S5644_063_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	063	0		29	10	S5644_063_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	063	0		29	10	S5644_063_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	064	0		29	10	S5644_064_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	064	0		29	10	S5644_064_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	064	0		29	10	S5644_064_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	064	0		29	10	S5644_064_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	065	0		29	10	S5644_065_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	065	0		29	10	S5644_065_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	065	0		29	10	S5644_065_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	065	0		29	10	S5644_065_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	067	0		29	10	S5644_067_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	067	0		29	10	S5644_067_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	067	0		29	10	S5644_067_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	068	0		29	10	S5644_068_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	068	0		29	10	S5644_068_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	068	0		29	10	S5644_068_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	071	0		29	10	S5644_071_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	071	0		29	10	S5644_071_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	071	0		29	10	S5644_071_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	072	0		29	10	S5644_072_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	072	0		29	10	S5644_072_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	072	0		29	10	S5644_072_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	073	0		29	10	S5644_073_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	073	0		29	10	S5644_073_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	073	0		29	10	S5644_073_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	074	0		29	10	S5644_074_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	074	0		29	10	S5644_074_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	074	0		29	10	S5644_074_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	075	0		29	10	S5644_075_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	075	0		29	10	S5644_075_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	075	0		29	10	S5644_075_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	076	0		29	10	S5644_076_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	076	0		29	10	S5644_076_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	076	0		29	10	S5644_076_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	078	0		29	10	S5644_078_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	078	0		29	10	S5644_078_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	078	0		29	10	S5644_078_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	079	0		29	10	S5644_079_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	079	0		29	10	S5644_079_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	079	0		29	10	S5644_079_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	080	0		29	10	S5644_080_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	080	0		29	10	S5644_080_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	080	0		29	10	S5644_080_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	081	0		29	10	S5644_081_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	081	0		29	10	S5644_081_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	081	0		29	10	S5644_081_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	082	0		29	10	S5644_082_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	082	0		29	10	S5644_082_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	082	0		29	10	S5644_082_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	083	0		29	10	S5644_083_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	083	0		29	10	S5644_083_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	083	0		29	10	S5644_083_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	084	0		29	10	S5644_084_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	084	0		29	10	S5644_084_0	9	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	084	0		29	10	S5644_084_0	9	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	085	0		29	10	S5644_085_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	085	0		29	10	S5644_085_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	085	0		29	10	S5644_085_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	087	0		29	10	S5644_087_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	087	0		29	10	S5644_087_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	087	0		29	10	S5644_087_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	174	0		29	10	S5644_174_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	174	0		29	10	S5644_174_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	174	0		29	10	S5644_174_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	174	0		29	10	S5644_174_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	175	0		29	10	S5644_175_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	175	0		29	10	S5644_175_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	175	0		29	10	S5644_175_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	175	0		29	10	S5644_175_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	176	0		29	10	S5644_176_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	176	0		29	10	S5644_176_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	176	0		29	10	S5644_176_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	176	0		29	10	S5644_176_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	177	0		29	10	S5644_177_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	177	0		29	10	S5644_177_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	177	0		29	10	S5644_177_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	177	0		29	10	S5644_177_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	178	0		29	10	S5644_178_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	178	0		29	10	S5644_178_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	178	0		29	10	S5644_178_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	178	0		29	10	S5644_178_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	179	0		29	10	S5644_179_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	179	0		29	10	S5644_179_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	179	0		29	10	S5644_179_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	179	0		29	10	S5644_179_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	180	0		29	10	S5644_180_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	180	0		29	10	S5644_180_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	180	0		29	10	S5644_180_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	180	0		29	10	S5644_180_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	181	0		29	10	S5644_181_0	10	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	181	0		29	10	S5644_181_0	10	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	181	0		29	10	S5644_181_0	10	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	181	0		29	10	S5644_181_0	10	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	182	0		29	10	S5644_182_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	182	0		29	10	S5644_182_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	182	0		29	10	S5644_182_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	182	0		29	10	S5644_182_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	183	0		29	10	S5644_183_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	183	0		29	10	S5644_183_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	183	0		29	10	S5644_183_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	183	0		29	10	S5644_183_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	184	0		29	10	S5644_184_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	184	0		29	10	S5644_184_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	184	0		29	10	S5644_184_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	184	0		29	10	S5644_184_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	185	0		29	10	S5644_185_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	185	0		29	10	S5644_185_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	185	0		29	10	S5644_185_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	185	0		29	10	S5644_185_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	186	0		29	10	S5644_186_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	186	0		29	10	S5644_186_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	186	0		29	10	S5644_186_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	186	0		29	10	S5644_186_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	187	0		29	10	S5644_187_0	9	1	1	Generic	001000		2	Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Generic	1	2		000011011010000011011	Generic																						Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	187	0		29	10	S5644_187_0	9	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Brand	1	2		000011011010000011011	Preferred Brand																						Preferred Brand				20.00	50.00		20.00	50.00		20.00						20.00	50.00		20.00	50.00			2
S5644	187	0		29	10	S5644_187_0	9	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	187	0		29	10	S5644_187_0	9	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Non-Preferred Brand	1	2		000011011010000011011	Non-Preferred Brand																						Non-Preferred Brand				40.00	100.00		40.00	100.00		40.00						40.00	100.00		40.00	100.00			2
S5644	188	0		29	10	S5644_188_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	188	0		29	10	S5644_188_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	188	0		29	10	S5644_188_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	189	0		29	10	S5644_189_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	189	0		29	10	S5644_189_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	189	0		29	10	S5644_189_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	190	0		29	10	S5644_190_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	190	0		29	10	S5644_190_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	190	0		29	10	S5644_190_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	191	0		29	10	S5644_191_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	191	0		29	10	S5644_191_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	191	0		29	10	S5644_191_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	192	0		29	10	S5644_192_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	192	0		29	10	S5644_192_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	192	0		29	10	S5644_192_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	193	0		29	10	S5644_193_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	193	0		29	10	S5644_193_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	193	0		29	10	S5644_193_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	194	0		29	10	S5644_194_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	194	0		29	10	S5644_194_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	194	0		29	10	S5644_194_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	195	0		29	10	S5644_195_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	195	0		29	10	S5644_195_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	195	0		29	10	S5644_195_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	196	0		29	10	S5644_196_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	196	0		29	10	S5644_196_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	196	0		29	10	S5644_196_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	197	0		29	10	S5644_197_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	197	0		29	10	S5644_197_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	197	0		29	10	S5644_197_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	198	0		29	10	S5644_198_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	198	0		29	10	S5644_198_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	198	0		29	10	S5644_198_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	199	0		29	10	S5644_199_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	199	0		29	10	S5644_199_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	199	0		29	10	S5644_199_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	200	0		29	10	S5644_200_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	200	0		29	10	S5644_200_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	200	0		29	10	S5644_200_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5644	201	0		29	10	S5644_201_0	8	1	1	Preferred Generic	001000		2	Preferred Generic	000011011010000011011				30	84		30	84		30						30	84		30	84		Preferred Generic	1	2		000011011010000011011	Preferred Generic																						Preferred Generic				5.00	10.00		5.00	10.00		5.00						5.00	10.00		5.00	10.00			2
S5644	201	0		29	10	S5644_201_0	8	2	1	Brand	000010		2	Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Brand	1	1	000011011010000011011		Brand				25	25		25	25		25						25	25		25	25		Brand																							2
S5644	201	0		29	10	S5644_201_0	8	3	1	Specialty Brand	000010		1	Specialty Brand	000011011010000011011				30	84		30	84		30						30	84		30	84		Specialty Brand	1	1	000011011010000011011		Specialty Brand				25	25		25	25		25						25	25		25	25		Specialty Brand																							2
S5650	003	0		29	10	S5650_003_0	3	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	010000000010010000000	31									31			31									Tier 1 - Generic	2	2		010000000010010000000	Tier 1 - Generic																						Tier 1 - Generic	5.00									5.00			5.00										3
S5650	003	0		29	10	S5650_003_0	3	4	1	Tier 4 - Specialty	110001		1	Tier 4 - Specialty	010000000010010000000	31									31			31									Tier 4 - Specialty	2	1	010000000010010000000		Tier 4 - Specialty	25									25			25									Tier 4 - Specialty																							3
S5650	003	0		29	10	S5650_003_0	3	3	1	Tier 3 - Non-Preferred Brand	100000		2	Tier 3 - Non-Preferred Brand	010000000010010000000	31									31			31									Tier 3 - Non-Preferred Brand	2	2		010000000010010000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	68.50									68.50			68.50										3
S5650	003	0		29	10	S5650_003_0	3	2	1	Tier 2 - Preferred Brand	000001		2	Tier 2 - Preferred Brand	010000000010010000000	31									31			31									Tier 2 - Preferred Brand	2	2		010000000010010000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	38.50									38.50			38.50										3
S5660	001	0		29	10	S5660_001_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	001	0		29	10	S5660_001_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	001	0		29	10	S5660_001_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	001	0		29	10	S5660_001_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	003	0		29	10	S5660_003_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	003	0		29	10	S5660_003_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	003	0		29	10	S5660_003_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	003	0		29	10	S5660_003_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	004	0		29	10	S5660_004_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	004	0		29	10	S5660_004_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	004	0		29	10	S5660_004_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	004	0		29	10	S5660_004_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	005	0		29	10	S5660_005_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	005	0		29	10	S5660_005_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	005	0		29	10	S5660_005_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	005	0		29	10	S5660_005_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	006	0		29	10	S5660_006_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	006	0		29	10	S5660_006_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	006	0		29	10	S5660_006_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	006	0		29	10	S5660_006_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	007	0		29	10	S5660_007_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	007	0		29	10	S5660_007_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	007	0		29	10	S5660_007_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	007	0		29	10	S5660_007_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	008	0		29	10	S5660_008_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	008	0		29	10	S5660_008_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	008	0		29	10	S5660_008_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	008	0		29	10	S5660_008_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	009	0		29	10	S5660_009_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	009	0		29	10	S5660_009_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	009	0		29	10	S5660_009_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	009	0		29	10	S5660_009_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	010	0		29	10	S5660_010_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	010	0		29	10	S5660_010_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	010	0		29	10	S5660_010_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	010	0		29	10	S5660_010_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	012	0		29	10	S5660_012_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	012	0		29	10	S5660_012_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	012	0		29	10	S5660_012_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	012	0		29	10	S5660_012_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	013	0		29	10	S5660_013_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	013	0		29	10	S5660_013_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	013	0		29	10	S5660_013_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	013	0		29	10	S5660_013_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	014	0		29	10	S5660_014_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	014	0		29	10	S5660_014_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	014	0		29	10	S5660_014_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	014	0		29	10	S5660_014_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	015	0		29	10	S5660_015_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	015	0		29	10	S5660_015_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	015	0		29	10	S5660_015_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	015	0		29	10	S5660_015_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	016	0		29	10	S5660_016_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	016	0		29	10	S5660_016_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	016	0		29	10	S5660_016_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	016	0		29	10	S5660_016_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	017	0		29	10	S5660_017_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	017	0		29	10	S5660_017_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	017	0		29	10	S5660_017_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	017	0		29	10	S5660_017_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	018	0		29	10	S5660_018_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	018	0		29	10	S5660_018_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	018	0		29	10	S5660_018_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	018	0		29	10	S5660_018_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	019	0		29	10	S5660_019_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	019	0		29	10	S5660_019_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	019	0		29	10	S5660_019_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	019	0		29	10	S5660_019_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	020	0		29	10	S5660_020_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	020	0		29	10	S5660_020_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	020	0		29	10	S5660_020_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	020	0		29	10	S5660_020_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	021	0		29	10	S5660_021_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	021	0		29	10	S5660_021_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	021	0		29	10	S5660_021_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	021	0		29	10	S5660_021_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	022	0		29	10	S5660_022_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	022	0		29	10	S5660_022_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	022	0		29	10	S5660_022_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	022	0		29	10	S5660_022_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	023	0		29	10	S5660_023_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	023	0		29	10	S5660_023_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	023	0		29	10	S5660_023_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	023	0		29	10	S5660_023_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	024	0		29	10	S5660_024_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	024	0		29	10	S5660_024_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	024	0		29	10	S5660_024_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	024	0		29	10	S5660_024_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	025	0		29	10	S5660_025_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	025	0		29	10	S5660_025_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	025	0		29	10	S5660_025_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	025	0		29	10	S5660_025_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	026	0		29	10	S5660_026_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	026	0		29	10	S5660_026_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	026	0		29	10	S5660_026_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	026	0		29	10	S5660_026_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	027	0		29	10	S5660_027_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	027	0		29	10	S5660_027_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	027	0		29	10	S5660_027_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	027	0		29	10	S5660_027_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	028	0		29	10	S5660_028_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	028	0		29	10	S5660_028_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	028	0		29	10	S5660_028_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	028	0		29	10	S5660_028_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	029	0		29	10	S5660_029_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	029	0		29	10	S5660_029_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	029	0		29	10	S5660_029_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	029	0		29	10	S5660_029_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	030	0		29	10	S5660_030_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	030	0		29	10	S5660_030_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	030	0		29	10	S5660_030_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	030	0		29	10	S5660_030_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	031	0		29	10	S5660_031_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	031	0		29	10	S5660_031_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	031	0		29	10	S5660_031_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	031	0		29	10	S5660_031_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	032	0		29	10	S5660_032_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	032	0		29	10	S5660_032_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	032	0		29	10	S5660_032_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	032	0		29	10	S5660_032_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	033	0		29	10	S5660_033_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	033	0		29	10	S5660_033_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	033	0		29	10	S5660_033_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	033	0		29	10	S5660_033_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	034	0		29	10	S5660_034_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	034	0		29	10	S5660_034_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	034	0		29	10	S5660_034_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	034	0		29	10	S5660_034_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	035	0		29	10	S5660_035_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5660	035	0		29	10	S5660_035_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	035	0		29	10	S5660_035_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	035	0		29	10	S5660_035_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	103	0		29	10	S5660_103_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5660	103	0		29	10	S5660_103_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5660	103	0		29	10	S5660_103_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5660	103	0		29	10	S5660_103_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5670	027	0		29	10	S5670_027_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	9.00	27.00								9.00				18.00									4
S5670	027	0		29	10	S5670_027_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	027	0		29	10	S5670_027_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00				136.00									4
S5670	027	0		29	10	S5670_027_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	028	0		29	10	S5670_028_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	028	0		29	10	S5670_028_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	028	0		29	10	S5670_028_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	60.00	180.00								60.00				120.00									3
S5670	028	0		29	10	S5670_028_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	030	0		29	10	S5670_030_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5670	030	0		29	10	S5670_030_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5670	030	0		29	10	S5670_030_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00				140.00									4
S5670	030	0		29	10	S5670_030_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	030	0		29	10	S5670_030_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	030	0		29	10	S5670_030_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	030	0		29	10	S5670_030_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	030	0		29	10	S5670_030_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	033	0		29	10	S5670_033_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5670	033	0		29	10	S5670_033_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	66.00	198.00								66.00				132.00									4
S5670	033	0		29	10	S5670_033_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	033	0		29	10	S5670_033_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	034	0		29	10	S5670_034_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	034	0		29	10	S5670_034_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	034	0		29	10	S5670_034_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	034	0		29	10	S5670_034_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	54.00	162.00								54.00				108.00									3
S5670	036	0		29	10	S5670_036_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5670	036	0		29	10	S5670_036_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									4
S5670	036	0		29	10	S5670_036_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	036	0		29	10	S5670_036_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	036	0		29	10	S5670_036_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	036	0		29	10	S5670_036_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	036	0		29	10	S5670_036_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	036	0		29	10	S5670_036_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	039	0		29	10	S5670_039_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5670	039	0		29	10	S5670_039_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	039	0		29	10	S5670_039_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00				136.00									4
S5670	039	0		29	10	S5670_039_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	040	0		29	10	S5670_040_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	56.00	168.00								56.00				112.00									3
S5670	040	0		29	10	S5670_040_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	040	0		29	10	S5670_040_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	040	0		29	10	S5670_040_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	042	0		29	10	S5670_042_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	042	0		29	10	S5670_042_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	042	0		29	10	S5670_042_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	042	0		29	10	S5670_042_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	042	0		29	10	S5670_042_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				201.00									4
S5670	042	0		29	10	S5670_042_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	042	0		29	10	S5670_042_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5670	042	0		29	10	S5670_042_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									4
S5670	045	0		29	10	S5670_045_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5670	045	0		29	10	S5670_045_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	045	0		29	10	S5670_045_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	045	0		29	10	S5670_045_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5670	046	0		29	10	S5670_046_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00				104.00									3
S5670	046	0		29	10	S5670_046_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	046	0		29	10	S5670_046_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	046	0		29	10	S5670_046_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	048	0		29	10	S5670_048_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	048	0		29	10	S5670_048_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	048	0		29	10	S5670_048_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	048	0		29	10	S5670_048_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	048	0		29	10	S5670_048_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	048	0		29	10	S5670_048_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	048	0		29	10	S5670_048_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
S5670	048	0		29	10	S5670_048_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	051	0		29	10	S5670_051_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	051	0		29	10	S5670_051_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	051	0		29	10	S5670_051_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5670	051	0		29	10	S5670_051_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	052	0		29	10	S5670_052_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	052	0		29	10	S5670_052_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	052	0		29	10	S5670_052_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	53.00	159.00								53.00				106.00									3
S5670	052	0		29	10	S5670_052_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	054	0		29	10	S5670_054_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	054	0		29	10	S5670_054_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	28.00	84.00								28.00				56.00									4
S5670	054	0		29	10	S5670_054_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
S5670	054	0		29	10	S5670_054_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	054	0		29	10	S5670_054_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	054	0		29	10	S5670_054_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	054	0		29	10	S5670_054_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	054	0		29	10	S5670_054_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	057	0		29	10	S5670_057_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									4
S5670	057	0		29	10	S5670_057_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	057	0		29	10	S5670_057_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	61.00	183.00								61.00				122.00									4
S5670	057	0		29	10	S5670_057_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	058	0		29	10	S5670_058_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	41.00	123.00								41.00				82.00									3
S5670	058	0		29	10	S5670_058_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	058	0		29	10	S5670_058_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	058	0		29	10	S5670_058_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	060	0		29	10	S5670_060_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
S5670	060	0		29	10	S5670_060_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									4
S5670	060	0		29	10	S5670_060_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	060	0		29	10	S5670_060_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	060	0		29	10	S5670_060_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	060	0		29	10	S5670_060_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	060	0		29	10	S5670_060_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	060	0		29	10	S5670_060_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	063	0		29	10	S5670_063_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5670	063	0		29	10	S5670_063_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	063	0		29	10	S5670_063_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	063	0		29	10	S5670_063_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	064	0		29	10	S5670_064_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	064	0		29	10	S5670_064_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	064	0		29	10	S5670_064_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	064	0		29	10	S5670_064_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	51.00	153.00								51.00				102.00									3
S5670	066	0		29	10	S5670_066_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5670	066	0		29	10	S5670_066_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5670	066	0		29	10	S5670_066_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5670	066	0		29	10	S5670_066_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	066	0		29	10	S5670_066_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	066	0		29	10	S5670_066_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	066	0		29	10	S5670_066_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	066	0		29	10	S5670_066_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	069	0		29	10	S5670_069_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5670	069	0		29	10	S5670_069_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	069	0		29	10	S5670_069_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5670	069	0		29	10	S5670_069_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	070	0		29	10	S5670_070_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00				104.00									3
S5670	070	0		29	10	S5670_070_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	070	0		29	10	S5670_070_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	070	0		29	10	S5670_070_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	072	0		29	10	S5670_072_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	072	0		29	10	S5670_072_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	072	0		29	10	S5670_072_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	072	0		29	10	S5670_072_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	072	0		29	10	S5670_072_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5670	072	0		29	10	S5670_072_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	072	0		29	10	S5670_072_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5670	072	0		29	10	S5670_072_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5670	075	0		29	10	S5670_075_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									3
S5670	075	0		29	10	S5670_075_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									3
S5670	075	0		29	10	S5670_075_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									3
S5670	075	0		29	10	S5670_075_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	076	0		29	10	S5670_076_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00				100.00									3
S5670	076	0		29	10	S5670_076_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	076	0		29	10	S5670_076_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	076	0		29	10	S5670_076_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	078	0		29	10	S5670_078_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5670	078	0		29	10	S5670_078_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5670	078	0		29	10	S5670_078_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	078	0		29	10	S5670_078_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	078	0		29	10	S5670_078_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	078	0		29	10	S5670_078_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	078	0		29	10	S5670_078_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	078	0		29	10	S5670_078_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	081	0		29	10	S5670_081_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	081	0		29	10	S5670_081_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	081	0		29	10	S5670_081_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	081	0		29	10	S5670_081_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5670	082	0		29	10	S5670_082_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	082	0		29	10	S5670_082_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	082	0		29	10	S5670_082_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00				104.00									3
S5670	082	0		29	10	S5670_082_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	084	0		29	10	S5670_084_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
S5670	084	0		29	10	S5670_084_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	084	0		29	10	S5670_084_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	23.00	69.00								23.00				46.00									4
S5670	084	0		29	10	S5670_084_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	66.00	198.00								66.00				132.00									4
S5670	084	0		29	10	S5670_084_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	084	0		29	10	S5670_084_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	084	0		29	10	S5670_084_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	084	0		29	10	S5670_084_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	087	0		29	10	S5670_087_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	087	0		29	10	S5670_087_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	087	0		29	10	S5670_087_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5670	087	0		29	10	S5670_087_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	088	0		29	10	S5670_088_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	088	0		29	10	S5670_088_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00				110.00									3
S5670	088	0		29	10	S5670_088_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	088	0		29	10	S5670_088_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	090	0		29	10	S5670_090_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	090	0		29	10	S5670_090_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5670	090	0		29	10	S5670_090_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	3.00	9.00								3.00				6.00									4
S5670	090	0		29	10	S5670_090_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	090	0		29	10	S5670_090_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	090	0		29	10	S5670_090_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	090	0		29	10	S5670_090_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	090	0		29	10	S5670_090_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	093	0		29	10	S5670_093_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	66.00	198.00								66.00				132.00									4
S5670	093	0		29	10	S5670_093_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	093	0		29	10	S5670_093_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	093	0		29	10	S5670_093_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5670	094	0		29	10	S5670_094_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	094	0		29	10	S5670_094_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	51.00	153.00								51.00				102.00									3
S5670	094	0		29	10	S5670_094_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	094	0		29	10	S5670_094_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	096	0		29	10	S5670_096_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	096	0		29	10	S5670_096_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	096	0		29	10	S5670_096_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	096	0		29	10	S5670_096_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	096	0		29	10	S5670_096_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
S5670	096	0		29	10	S5670_096_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	096	0		29	10	S5670_096_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5670	096	0		29	10	S5670_096_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	099	0		29	10	S5670_099_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5670	099	0		29	10	S5670_099_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	099	0		29	10	S5670_099_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5670	099	0		29	10	S5670_099_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	100	0		29	10	S5670_100_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	100	0		29	10	S5670_100_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	100	0		29	10	S5670_100_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	51.00	153.00								51.00				102.00									3
S5670	100	0		29	10	S5670_100_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	102	0		29	10	S5670_102_0	5	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	102	0		29	10	S5670_102_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	102	0		29	10	S5670_102_0	5	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	102	0		29	10	S5670_102_0	5	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	102	0		29	10	S5670_102_0	5	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	66.00	198.00								66.00				132.00									4
S5670	102	0		29	10	S5670_102_0	5	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	102	0		29	10	S5670_102_0	5	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5670	102	0		29	10	S5670_102_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	105	0		29	10	S5670_105_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	105	0		29	10	S5670_105_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	105	0		29	10	S5670_105_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	6.00	18.00								6.00				12.00									4
S5670	105	0		29	10	S5670_105_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	106	0		29	10	S5670_106_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	47.00	141.00								47.00				94.00									3
S5670	106	0		29	10	S5670_106_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	106	0		29	10	S5670_106_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	106	0		29	10	S5670_106_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	108	0		29	10	S5670_108_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00				136.00									4
S5670	108	0		29	10	S5670_108_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	108	0		29	10	S5670_108_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
S5670	108	0		29	10	S5670_108_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	108	0		29	10	S5670_108_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	108	0		29	10	S5670_108_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	108	0		29	10	S5670_108_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	108	0		29	10	S5670_108_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	111	0		29	10	S5670_111_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	111	0		29	10	S5670_111_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5670	111	0		29	10	S5670_111_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	62.00	186.00								62.00				124.00									4
S5670	111	0		29	10	S5670_111_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	112	0		29	10	S5670_112_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	112	0		29	10	S5670_112_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	112	0		29	10	S5670_112_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	53.00	159.00								53.00				106.00									3
S5670	112	0		29	10	S5670_112_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	114	0		29	10	S5670_114_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5670	114	0		29	10	S5670_114_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5670	114	0		29	10	S5670_114_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	114	0		29	10	S5670_114_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	114	0		29	10	S5670_114_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	114	0		29	10	S5670_114_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	114	0		29	10	S5670_114_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	114	0		29	10	S5670_114_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	117	0		29	10	S5670_117_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	117	0		29	10	S5670_117_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	117	0		29	10	S5670_117_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5670	117	0		29	10	S5670_117_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	118	0		29	10	S5670_118_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	57.00	171.00								57.00				114.00									3
S5670	118	0		29	10	S5670_118_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	118	0		29	10	S5670_118_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	118	0		29	10	S5670_118_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	120	0		29	10	S5670_120_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	120	0		29	10	S5670_120_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	120	0		29	10	S5670_120_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	120	0		29	10	S5670_120_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	120	0		29	10	S5670_120_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	120	0		29	10	S5670_120_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	120	0		29	10	S5670_120_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5670	120	0		29	10	S5670_120_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				58.00									4
S5670	123	0		29	10	S5670_123_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00				136.00									4
S5670	123	0		29	10	S5670_123_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	123	0		29	10	S5670_123_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5670	123	0		29	10	S5670_123_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	124	0		29	10	S5670_124_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	56.00	168.00								56.00				112.00									3
S5670	124	0		29	10	S5670_124_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	124	0		29	10	S5670_124_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	124	0		29	10	S5670_124_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	126	0		29	10	S5670_126_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	126	0		29	10	S5670_126_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	126	0		29	10	S5670_126_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	126	0		29	10	S5670_126_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	126	0		29	10	S5670_126_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	126	0		29	10	S5670_126_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	126	0		29	10	S5670_126_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5670	126	0		29	10	S5670_126_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				58.00									4
S5670	129	0		29	10	S5670_129_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5670	129	0		29	10	S5670_129_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	129	0		29	10	S5670_129_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	129	0		29	10	S5670_129_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00				136.00									4
S5670	130	0		29	10	S5670_130_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00				104.00									3
S5670	130	0		29	10	S5670_130_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	130	0		29	10	S5670_130_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	130	0		29	10	S5670_130_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	132	0		29	10	S5670_132_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	132	0		29	10	S5670_132_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	132	0		29	10	S5670_132_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	132	0		29	10	S5670_132_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	132	0		29	10	S5670_132_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	132	0		29	10	S5670_132_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	132	0		29	10	S5670_132_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5670	132	0		29	10	S5670_132_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	135	0		29	10	S5670_135_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	9.00	27.00								9.00				18.00									4
S5670	135	0		29	10	S5670_135_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	135	0		29	10	S5670_135_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5670	135	0		29	10	S5670_135_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	136	0		29	10	S5670_136_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	136	0		29	10	S5670_136_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	136	0		29	10	S5670_136_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	56.00	168.00								56.00				112.00									3
S5670	136	0		29	10	S5670_136_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	138	0		29	10	S5670_138_0	6	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	138	0		29	10	S5670_138_0	6	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	138	0		29	10	S5670_138_0	6	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00				136.00									4
S5670	138	0		29	10	S5670_138_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	23.00	69.00								23.00				46.00									4
S5670	138	0		29	10	S5670_138_0	6	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5670	138	0		29	10	S5670_138_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	138	0		29	10	S5670_138_0	6	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	138	0		29	10	S5670_138_0	6	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	141	0		29	10	S5670_141_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	9.00	27.00								9.00				18.00									4
S5670	141	0		29	10	S5670_141_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	141	0		29	10	S5670_141_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	141	0		29	10	S5670_141_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	142	0		29	10	S5670_142_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	142	0		29	10	S5670_142_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	59.00	177.00								59.00				118.00									3
S5670	142	0		29	10	S5670_142_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	142	0		29	10	S5670_142_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	144	0		29	10	S5670_144_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5670	144	0		29	10	S5670_144_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	78.00								26.00				52.00									4
S5670	144	0		29	10	S5670_144_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5670	144	0		29	10	S5670_144_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	144	0		29	10	S5670_144_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	144	0		29	10	S5670_144_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	144	0		29	10	S5670_144_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	144	0		29	10	S5670_144_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	147	0		29	10	S5670_147_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5670	147	0		29	10	S5670_147_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	147	0		29	10	S5670_147_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00				20.00									4
S5670	147	0		29	10	S5670_147_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	148	0		29	10	S5670_148_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	63.00	189.00								63.00				126.00									3
S5670	148	0		29	10	S5670_148_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5670	148	0		29	10	S5670_148_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5670	148	0		29	10	S5670_148_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5670	150	0		29	10	S5670_150_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5670	150	0		29	10	S5670_150_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5670	150	0		29	10	S5670_150_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5670	150	0		29	10	S5670_150_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5670	150	0		29	10	S5670_150_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5670	150	0		29	10	S5670_150_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00				140.00									4
S5670	150	0		29	10	S5670_150_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5670	150	0		29	10	S5670_150_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	002	0		29	10	S5674_002_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	62.00	186.00								62.00				124.00									4
S5674	002	0		29	10	S5674_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	002	0		29	10	S5674_002_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5674	002	0		29	10	S5674_002_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	003	0		29	10	S5674_003_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	003	0		29	10	S5674_003_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	003	0		29	10	S5674_003_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	49.00	147.00								49.00				98.00									3
S5674	003	0		29	10	S5674_003_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	005	0		29	10	S5674_005_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00				140.00									4
S5674	005	0		29	10	S5674_005_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									4
S5674	005	0		29	10	S5674_005_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	0.00	0.00								0.00				0.00									4
S5674	005	0		29	10	S5674_005_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	005	0		29	10	S5674_005_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	005	0		29	10	S5674_005_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	005	0		29	10	S5674_005_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	005	0		29	10	S5674_005_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	008	0		29	10	S5674_008_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	7.00	21.00								7.00				14.00									4
S5674	008	0		29	10	S5674_008_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	008	0		29	10	S5674_008_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00				140.00									4
S5674	008	0		29	10	S5674_008_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	009	0		29	10	S5674_009_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00				104.00									3
S5674	009	0		29	10	S5674_009_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	009	0		29	10	S5674_009_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	009	0		29	10	S5674_009_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	011	0		29	10	S5674_011_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	60.00	180.00								60.00				120.00									4
S5674	011	0		29	10	S5674_011_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									4
S5674	011	0		29	10	S5674_011_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	011	0		29	10	S5674_011_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	011	0		29	10	S5674_011_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	011	0		29	10	S5674_011_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	011	0		29	10	S5674_011_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	011	0		29	10	S5674_011_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5674	014	0		29	10	S5674_014_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	66.00	198.00								66.00				132.00									4
S5674	014	0		29	10	S5674_014_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	014	0		29	10	S5674_014_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00				20.00									4
S5674	014	0		29	10	S5674_014_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	015	0		29	10	S5674_015_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	015	0		29	10	S5674_015_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	015	0		29	10	S5674_015_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	61.00	183.00								61.00				122.00									3
S5674	015	0		29	10	S5674_015_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	017	0		29	10	S5674_017_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5674	017	0		29	10	S5674_017_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5674	017	0		29	10	S5674_017_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	3.00	9.00								3.00				6.00									4
S5674	017	0		29	10	S5674_017_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	017	0		29	10	S5674_017_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	017	0		29	10	S5674_017_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	017	0		29	10	S5674_017_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	017	0		29	10	S5674_017_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	020	0		29	10	S5674_020_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	020	0		29	10	S5674_020_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	186.00								67.00				134.00									4
S5674	020	0		29	10	S5674_020_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	020	0		29	10	S5674_020_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	9.00	27.00								9.00				18.00									4
S5674	021	0		29	10	S5674_021_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	58.00	174.00								58.00				116.00									3
S5674	021	0		29	10	S5674_021_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	021	0		29	10	S5674_021_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	021	0		29	10	S5674_021_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	023	0		29	10	S5674_023_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	023	0		29	10	S5674_023_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	023	0		29	10	S5674_023_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	023	0		29	10	S5674_023_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	023	0		29	10	S5674_023_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5674	023	0		29	10	S5674_023_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5674	023	0		29	10	S5674_023_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5674	023	0		29	10	S5674_023_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	026	0		29	10	S5674_026_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5674	026	0		29	10	S5674_026_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	026	0		29	10	S5674_026_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5674	026	0		29	10	S5674_026_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	027	0		29	10	S5674_027_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	54.00	162.00								54.00				108.00									3
S5674	027	0		29	10	S5674_027_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	027	0		29	10	S5674_027_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	027	0		29	10	S5674_027_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	029	0		29	10	S5674_029_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5674	029	0		29	10	S5674_029_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5674	029	0		29	10	S5674_029_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5674	029	0		29	10	S5674_029_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	029	0		29	10	S5674_029_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	029	0		29	10	S5674_029_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	029	0		29	10	S5674_029_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	029	0		29	10	S5674_029_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	032	0		29	10	S5674_032_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	63.00	189.00								63.00				126.00									4
S5674	032	0		29	10	S5674_032_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	032	0		29	10	S5674_032_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5674	032	0		29	10	S5674_032_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	033	0		29	10	S5674_033_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	033	0		29	10	S5674_033_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	033	0		29	10	S5674_033_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	53.00	159.00								53.00				106.00									3
S5674	033	0		29	10	S5674_033_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	035	0		29	10	S5674_035_0	6	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5674	035	0		29	10	S5674_035_0	6	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	035	0		29	10	S5674_035_0	6	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5674	035	0		29	10	S5674_035_0	6	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	035	0		29	10	S5674_035_0	6	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	035	0		29	10	S5674_035_0	6	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	035	0		29	10	S5674_035_0	6	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	035	0		29	10	S5674_035_0	6	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	038	0		29	10	S5674_038_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5674	038	0		29	10	S5674_038_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	038	0		29	10	S5674_038_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5674	038	0		29	10	S5674_038_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	039	0		29	10	S5674_039_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	54.00	162.00								54.00				108.00									3
S5674	039	0		29	10	S5674_039_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	039	0		29	10	S5674_039_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	039	0		29	10	S5674_039_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	041	0		29	10	S5674_041_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	041	0		29	10	S5674_041_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	041	0		29	10	S5674_041_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	041	0		29	10	S5674_041_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	041	0		29	10	S5674_041_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5674	041	0		29	10	S5674_041_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	041	0		29	10	S5674_041_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5674	041	0		29	10	S5674_041_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	044	0		29	10	S5674_044_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00				136.00									4
S5674	044	0		29	10	S5674_044_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	044	0		29	10	S5674_044_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	8.00	24.00								8.00				16.00									4
S5674	044	0		29	10	S5674_044_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	045	0		29	10	S5674_045_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00				110.00									3
S5674	045	0		29	10	S5674_045_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	045	0		29	10	S5674_045_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	045	0		29	10	S5674_045_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	047	0		29	10	S5674_047_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5674	047	0		29	10	S5674_047_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00				44.00									4
S5674	047	0		29	10	S5674_047_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5674	047	0		29	10	S5674_047_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	047	0		29	10	S5674_047_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	010000000010000000000	30									30												Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	047	0		29	10	S5674_047_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	047	0		29	10	S5674_047_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	047	0		29	10	S5674_047_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	050	0		29	10	S5674_050_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	050	0		29	10	S5674_050_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	64.00	192.00								64.00				128.00									4
S5674	050	0		29	10	S5674_050_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	050	0		29	10	S5674_050_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	9.00	27.00								9.00				18.00									4
S5674	051	0		29	10	S5674_051_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	57.00	171.00								57.00				114.00									3
S5674	051	0		29	10	S5674_051_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	051	0		29	10	S5674_051_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	051	0		29	10	S5674_051_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	053	0		29	10	S5674_053_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	053	0		29	10	S5674_053_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	053	0		29	10	S5674_053_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	053	0		29	10	S5674_053_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	053	0		29	10	S5674_053_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5674	053	0		29	10	S5674_053_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	23.00	69.00								23.00				46.00									4
S5674	053	0		29	10	S5674_053_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5674	053	0		29	10	S5674_053_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	056	0		29	10	S5674_056_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	64.00	192.00								64.00				128.00									4
S5674	056	0		29	10	S5674_056_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	056	0		29	10	S5674_056_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	9.00	27.00								9.00				18.00									4
S5674	056	0		29	10	S5674_056_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	057	0		29	10	S5674_057_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	56.00	168.00								56.00				112.00									3
S5674	057	0		29	10	S5674_057_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	057	0		29	10	S5674_057_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	057	0		29	10	S5674_057_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	059	0		29	10	S5674_059_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	1.00	3.00								1.00				2.00									4
S5674	059	0		29	10	S5674_059_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	059	0		29	10	S5674_059_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	69.00	207.00								69.00				138.00									4
S5674	059	0		29	10	S5674_059_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	059	0		29	10	S5674_059_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	059	0		29	10	S5674_059_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	059	0		29	10	S5674_059_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	059	0		29	10	S5674_059_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	062	0		29	10	S5674_062_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	9.00	27.00								9.00				18.00									4
S5674	062	0		29	10	S5674_062_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	062	0		29	10	S5674_062_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00				136.00									4
S5674	062	0		29	10	S5674_062_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	063	0		29	10	S5674_063_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	063	0		29	10	S5674_063_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	58.00	174.00								58.00				116.00									3
S5674	063	0		29	10	S5674_063_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	063	0		29	10	S5674_063_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	065	0		29	10	S5674_065_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	065	0		29	10	S5674_065_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	065	0		29	10	S5674_065_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	065	0		29	10	S5674_065_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	065	0		29	10	S5674_065_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	065	0		29	10	S5674_065_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5674	065	0		29	10	S5674_065_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	065	0		29	10	S5674_065_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				4.00									4
S5674	068	0		29	10	S5674_068_0	3	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5674	068	0		29	10	S5674_068_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	67.00	201.00								67.00				134.00									4
S5674	068	0		29	10	S5674_068_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	068	0		29	10	S5674_068_0	3	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	10.00	30.00								10.00				20.00									4
S5674	069	0		29	10	S5674_069_0	3	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				10.00									3
S5674	069	0		29	10	S5674_069_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									3
S5674	069	0		29	10	S5674_069_0	3	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	63.00	189.00								63.00				126.00									3
S5674	069	0		29	10	S5674_069_0	3	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							3
S5674	071	0		29	10	S5674_071_0	4	1	1	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	3.00	9.00								3.00				6.00									4
S5674	071	0		29	10	S5674_071_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	1	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				50.00									4
S5674	071	0		29	10	S5674_071_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010001000000	30	90								30				90								Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010001000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00				130.00									4
S5674	071	0		29	10	S5674_071_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5674	071	0		29	10	S5674_071_0	4	1	3	Preferred Generic	001001	3	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	1	2		011000000010001000000	Preferred Generic																						Preferred Generic	15.00	45.00								15.00				30.00								1	4
S5674	071	0		29	10	S5674_071_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5674	071	0		29	10	S5674_071_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5674	071	0		29	10	S5674_071_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	010000000010000000000		Specialty Drugs	25									25												Specialty Drugs																							4
S5678	001	0		29	10	S5678_001_0	6	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	001	0		29	10	S5678_001_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	31.00	93.00	62.00							31.00	93.00	62.00		62.00	62.00								3
S5678	001	0		29	10	S5678_001_0	6	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	001	0		29	10	S5678_001_0	6	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	002	0		29	10	S5678_002_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	002	0		29	10	S5678_002_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	31.00	93.00	62.00							31.00	93.00	62.00		62.00	62.00								3
S5678	002	0		29	10	S5678_002_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	002	0		29	10	S5678_002_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	003	0		29	10	S5678_003_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	003	0		29	10	S5678_003_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	003	0		29	10	S5678_003_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	003	0		29	10	S5678_003_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	004	0		29	10	S5678_004_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	004	0		29	10	S5678_004_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	32.00	96.00	64.00							32.00	96.00	64.00		64.00	64.00								3
S5678	004	0		29	10	S5678_004_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	004	0		29	10	S5678_004_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	005	0		29	10	S5678_005_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	005	0		29	10	S5678_005_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	005	0		29	10	S5678_005_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	005	0		29	10	S5678_005_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	006	0		29	10	S5678_006_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	006	0		29	10	S5678_006_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	006	0		29	10	S5678_006_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	006	0		29	10	S5678_006_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	007	0		29	10	S5678_007_0	4	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	007	0		29	10	S5678_007_0	4	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								3
S5678	007	0		29	10	S5678_007_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								3
S5678	007	0		29	10	S5678_007_0	4	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	007	0		29	10	S5678_007_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	008	0		29	10	S5678_008_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	008	0		29	10	S5678_008_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	008	0		29	10	S5678_008_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	008	0		29	10	S5678_008_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								3
S5678	008	0		29	10	S5678_008_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								3
S5678	009	0		29	10	S5678_009_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	009	0		29	10	S5678_009_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	009	0		29	10	S5678_009_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	009	0		29	10	S5678_009_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	009	0		29	10	S5678_009_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	010	0		29	10	S5678_010_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	010	0		29	10	S5678_010_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	010	0		29	10	S5678_010_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	010	0		29	10	S5678_010_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	010	0		29	10	S5678_010_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	011	0		29	10	S5678_011_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	011	0		29	10	S5678_011_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	011	0		29	10	S5678_011_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	011	0		29	10	S5678_011_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	011	0		29	10	S5678_011_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	012	0		29	10	S5678_012_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	012	0		29	10	S5678_012_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	012	0		29	10	S5678_012_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	012	0		29	10	S5678_012_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	012	0		29	10	S5678_012_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	013	0		29	10	S5678_013_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	013	0		29	10	S5678_013_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	013	0		29	10	S5678_013_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	013	0		29	10	S5678_013_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	013	0		29	10	S5678_013_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	014	0		29	10	S5678_014_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	014	0		29	10	S5678_014_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	014	0		29	10	S5678_014_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	014	0		29	10	S5678_014_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	015	0		29	10	S5678_015_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	015	0		29	10	S5678_015_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	015	0		29	10	S5678_015_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	015	0		29	10	S5678_015_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	015	0		29	10	S5678_015_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	016	0		29	10	S5678_016_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	016	0		29	10	S5678_016_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	016	0		29	10	S5678_016_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	016	0		29	10	S5678_016_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	32.00	96.00	64.00							32.00	96.00	64.00		64.00	64.00								3
S5678	017	0		29	10	S5678_017_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	017	0		29	10	S5678_017_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	017	0		29	10	S5678_017_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	017	0		29	10	S5678_017_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	017	0		29	10	S5678_017_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	018	0		29	10	S5678_018_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	018	0		29	10	S5678_018_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	018	0		29	10	S5678_018_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	018	0		29	10	S5678_018_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	019	0		29	10	S5678_019_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	019	0		29	10	S5678_019_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	019	0		29	10	S5678_019_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	019	0		29	10	S5678_019_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	019	0		29	10	S5678_019_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	020	0		29	10	S5678_020_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	020	0		29	10	S5678_020_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	020	0		29	10	S5678_020_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	020	0		29	10	S5678_020_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	021	0		29	10	S5678_021_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	021	0		29	10	S5678_021_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	021	0		29	10	S5678_021_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	021	0		29	10	S5678_021_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	021	0		29	10	S5678_021_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	022	0		29	10	S5678_022_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	022	0		29	10	S5678_022_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	022	0		29	10	S5678_022_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	022	0		29	10	S5678_022_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	023	0		29	10	S5678_023_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	023	0		29	10	S5678_023_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	023	0		29	10	S5678_023_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	023	0		29	10	S5678_023_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	023	0		29	10	S5678_023_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	024	0		29	10	S5678_024_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	024	0		29	10	S5678_024_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	024	0		29	10	S5678_024_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	024	0		29	10	S5678_024_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	025	0		29	10	S5678_025_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	025	0		29	10	S5678_025_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	025	0		29	10	S5678_025_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	025	0		29	10	S5678_025_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	025	0		29	10	S5678_025_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	026	0		29	10	S5678_026_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	026	0		29	10	S5678_026_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	026	0		29	10	S5678_026_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	026	0		29	10	S5678_026_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	027	0		29	10	S5678_027_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								3
S5678	027	0		29	10	S5678_027_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	027	0		29	10	S5678_027_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	027	0		29	10	S5678_027_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								3
S5678	027	0		29	10	S5678_027_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	028	0		29	10	S5678_028_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	028	0		29	10	S5678_028_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	31.00	93.00	62.00							31.00	93.00	62.00		62.00	62.00								3
S5678	028	0		29	10	S5678_028_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	028	0		29	10	S5678_028_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	029	0		29	10	S5678_029_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	029	0		29	10	S5678_029_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	029	0		29	10	S5678_029_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	029	0		29	10	S5678_029_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	029	0		29	10	S5678_029_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	030	0		29	10	S5678_030_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	030	0		29	10	S5678_030_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	030	0		29	10	S5678_030_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	030	0		29	10	S5678_030_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	031	0		29	10	S5678_031_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	031	0		29	10	S5678_031_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	031	0		29	10	S5678_031_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	031	0		29	10	S5678_031_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	031	0		29	10	S5678_031_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	032	0		29	10	S5678_032_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	032	0		29	10	S5678_032_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	032	0		29	10	S5678_032_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	032	0		29	10	S5678_032_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	033	0		29	10	S5678_033_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	033	0		29	10	S5678_033_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	033	0		29	10	S5678_033_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	033	0		29	10	S5678_033_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	033	0		29	10	S5678_033_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	034	0		29	10	S5678_034_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	034	0		29	10	S5678_034_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	034	0		29	10	S5678_034_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	32.00	96.00	64.00							32.00	96.00	64.00		64.00	64.00								3
S5678	034	0		29	10	S5678_034_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	035	0		29	10	S5678_035_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	035	0		29	10	S5678_035_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	035	0		29	10	S5678_035_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	035	0		29	10	S5678_035_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	035	0		29	10	S5678_035_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	036	0		29	10	S5678_036_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	036	0		29	10	S5678_036_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	036	0		29	10	S5678_036_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	036	0		29	10	S5678_036_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	037	0		29	10	S5678_037_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	037	0		29	10	S5678_037_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	037	0		29	10	S5678_037_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	037	0		29	10	S5678_037_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	037	0		29	10	S5678_037_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	038	0		29	10	S5678_038_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	038	0		29	10	S5678_038_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	038	0		29	10	S5678_038_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	32.00	96.00	64.00							32.00	96.00	64.00		64.00	64.00								3
S5678	038	0		29	10	S5678_038_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	039	0		29	10	S5678_039_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	039	0		29	10	S5678_039_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	039	0		29	10	S5678_039_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	039	0		29	10	S5678_039_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	039	0		29	10	S5678_039_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	040	0		29	10	S5678_040_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	040	0		29	10	S5678_040_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	040	0		29	10	S5678_040_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	040	0		29	10	S5678_040_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	041	0		29	10	S5678_041_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	041	0		29	10	S5678_041_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	041	0		29	10	S5678_041_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	041	0		29	10	S5678_041_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	041	0		29	10	S5678_041_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	042	0		29	10	S5678_042_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	042	0		29	10	S5678_042_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	042	0		29	10	S5678_042_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	042	0		29	10	S5678_042_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	043	0		29	10	S5678_043_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	043	0		29	10	S5678_043_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	043	0		29	10	S5678_043_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	043	0		29	10	S5678_043_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	043	0		29	10	S5678_043_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	044	0		29	10	S5678_044_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	044	0		29	10	S5678_044_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	044	0		29	10	S5678_044_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	044	0		29	10	S5678_044_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	045	0		29	10	S5678_045_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	045	0		29	10	S5678_045_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	045	0		29	10	S5678_045_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	045	0		29	10	S5678_045_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	045	0		29	10	S5678_045_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	046	0		29	10	S5678_046_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	046	0		29	10	S5678_046_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	046	0		29	10	S5678_046_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	046	0		29	10	S5678_046_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	047	0		29	10	S5678_047_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	047	0		29	10	S5678_047_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	047	0		29	10	S5678_047_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	047	0		29	10	S5678_047_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	047	0		29	10	S5678_047_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	048	0		29	10	S5678_048_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	048	0		29	10	S5678_048_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	048	0		29	10	S5678_048_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	048	0		29	10	S5678_048_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	049	0		29	10	S5678_049_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	049	0		29	10	S5678_049_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	049	0		29	10	S5678_049_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	049	0		29	10	S5678_049_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	049	0		29	10	S5678_049_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	050	0		29	10	S5678_050_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	050	0		29	10	S5678_050_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	050	0		29	10	S5678_050_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	050	0		29	10	S5678_050_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	051	0		29	10	S5678_051_0	2	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	051	0		29	10	S5678_051_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	051	0		29	10	S5678_051_0	2	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	051	0		29	10	S5678_051_0	2	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	051	0		29	10	S5678_051_0	2	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	052	0		29	10	S5678_052_0	4	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	052	0		29	10	S5678_052_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	052	0		29	10	S5678_052_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	052	0		29	10	S5678_052_0	4	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	053	0		29	10	S5678_053_0	1	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	053	0		29	10	S5678_053_0	1	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	053	0		29	10	S5678_053_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	053	0		29	10	S5678_053_0	1	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	053	0		29	10	S5678_053_0	1	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	054	0		29	10	S5678_054_0	3	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	054	0		29	10	S5678_054_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	054	0		29	10	S5678_054_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	054	0		29	10	S5678_054_0	3	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	055	0		29	10	S5678_055_0	1	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	055	0		29	10	S5678_055_0	1	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	055	0		29	10	S5678_055_0	1	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	055	0		29	10	S5678_055_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	055	0		29	10	S5678_055_0	1	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	056	0		29	10	S5678_056_0	3	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	056	0		29	10	S5678_056_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	32.00	96.00	64.00							32.00	96.00	64.00		64.00	64.00								3
S5678	056	0		29	10	S5678_056_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	056	0		29	10	S5678_056_0	3	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	057	0		29	10	S5678_057_0	1	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	057	0		29	10	S5678_057_0	1	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								3
S5678	057	0		29	10	S5678_057_0	1	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	057	0		29	10	S5678_057_0	1	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	057	0		29	10	S5678_057_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								3
S5678	058	0		29	10	S5678_058_0	3	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	058	0		29	10	S5678_058_0	3	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	058	0		29	10	S5678_058_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	31.00	93.00	62.00							31.00	93.00	62.00		62.00	62.00								3
S5678	058	0		29	10	S5678_058_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	059	0		29	10	S5678_059_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								3
S5678	059	0		29	10	S5678_059_0	1	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								3
S5678	059	0		29	10	S5678_059_0	1	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	059	0		29	10	S5678_059_0	1	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	059	0		29	10	S5678_059_0	1	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	060	0		29	10	S5678_060_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	060	0		29	10	S5678_060_0	3	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	060	0		29	10	S5678_060_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	31.00	93.00	62.00							31.00	93.00	62.00		62.00	62.00								3
S5678	060	0		29	10	S5678_060_0	3	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	061	0		29	10	S5678_061_0	1	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	061	0		29	10	S5678_061_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								3
S5678	061	0		29	10	S5678_061_0	1	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								3
S5678	061	0		29	10	S5678_061_0	1	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	061	0		29	10	S5678_061_0	1	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	062	0		29	10	S5678_062_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	31.00	93.00	62.00							31.00	93.00	62.00		62.00	62.00								3
S5678	062	0		29	10	S5678_062_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	062	0		29	10	S5678_062_0	3	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	062	0		29	10	S5678_062_0	3	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	063	0		29	10	S5678_063_0	1	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	063	0		29	10	S5678_063_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	063	0		29	10	S5678_063_0	1	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	063	0		29	10	S5678_063_0	1	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	063	0		29	10	S5678_063_0	1	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	064	0		29	10	S5678_064_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	064	0		29	10	S5678_064_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	064	0		29	10	S5678_064_0	3	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	064	0		29	10	S5678_064_0	3	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	065	0		29	10	S5678_065_0	1	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	065	0		29	10	S5678_065_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								3
S5678	065	0		29	10	S5678_065_0	1	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	065	0		29	10	S5678_065_0	1	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								3
S5678	065	0		29	10	S5678_065_0	1	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	066	0		29	10	S5678_066_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	31.00	93.00	62.00							31.00	93.00	62.00		62.00	62.00								3
S5678	066	0		29	10	S5678_066_0	3	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	066	0		29	10	S5678_066_0	3	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	066	0		29	10	S5678_066_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	067	0		29	10	S5678_067_0	1	5	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							3
S5678	067	0		29	10	S5678_067_0	1	4	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							3
S5678	067	0		29	10	S5678_067_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								3
S5678	067	0		29	10	S5678_067_0	1	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	5.00	15.00	10.00							5.00	15.00	10.00		10.00	10.00								3
S5678	067	0		29	10	S5678_067_0	1	3	1	Non-Preferred	100100		2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								3
S5678	068	0		29	10	S5678_068_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	29.00	87.00	58.00							29.00	87.00	58.00		58.00	58.00								3
S5678	068	0		29	10	S5678_068_0	3	3	1	Injectables	010010		2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	25	25	25							25	25	25		25	25							Injectables																							3
S5678	068	0		29	10	S5678_068_0	3	4	1	Specialty	010010		1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	25	25	25							25	25	25		25	25							Specialty																							3
S5678	068	0		29	10	S5678_068_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00	0.00								3
S5678	069	0		29	10	S5678_069_0	4	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	069	0		29	10	S5678_069_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	069	0		29	10	S5678_069_0	4	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00							1	4
S5678	069	0		29	10	S5678_069_0	4	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	069	0		29	10	S5678_069_0	4	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	069	0		29	10	S5678_069_0	4	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								4
S5678	069	0		29	10	S5678_069_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								4
S5678	069	0		29	10	S5678_069_0	4	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00								4
S5678	069	0		29	10	S5678_069_0	4	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	069	0		29	10	S5678_069_0	4	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	070	0		29	10	S5678_070_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00								4
S5678	070	0		29	10	S5678_070_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								4
S5678	070	0		29	10	S5678_070_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	070	0		29	10	S5678_070_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	070	0		29	10	S5678_070_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	070	0		29	10	S5678_070_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	070	0		29	10	S5678_070_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00							1	4
S5678	070	0		29	10	S5678_070_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	070	0		29	10	S5678_070_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	070	0		29	10	S5678_070_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								4
S5678	071	0		29	10	S5678_071_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	071	0		29	10	S5678_071_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	071	0		29	10	S5678_071_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	071	0		29	10	S5678_071_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	071	0		29	10	S5678_071_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	071	0		29	10	S5678_071_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	071	0		29	10	S5678_071_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	071	0		29	10	S5678_071_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	071	0		29	10	S5678_071_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	071	0		29	10	S5678_071_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	072	0		29	10	S5678_072_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	072	0		29	10	S5678_072_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	072	0		29	10	S5678_072_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	072	0		29	10	S5678_072_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	072	0		29	10	S5678_072_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	072	0		29	10	S5678_072_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	072	0		29	10	S5678_072_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	072	0		29	10	S5678_072_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	072	0		29	10	S5678_072_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	072	0		29	10	S5678_072_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	073	0		29	10	S5678_073_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	073	0		29	10	S5678_073_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	073	0		29	10	S5678_073_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	073	0		29	10	S5678_073_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	073	0		29	10	S5678_073_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	073	0		29	10	S5678_073_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	073	0		29	10	S5678_073_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	073	0		29	10	S5678_073_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	073	0		29	10	S5678_073_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	073	0		29	10	S5678_073_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	074	0		29	10	S5678_074_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	074	0		29	10	S5678_074_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	074	0		29	10	S5678_074_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	074	0		29	10	S5678_074_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	074	0		29	10	S5678_074_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	074	0		29	10	S5678_074_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	074	0		29	10	S5678_074_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	074	0		29	10	S5678_074_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	074	0		29	10	S5678_074_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	074	0		29	10	S5678_074_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	075	0		29	10	S5678_075_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	075	0		29	10	S5678_075_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	075	0		29	10	S5678_075_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	075	0		29	10	S5678_075_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	075	0		29	10	S5678_075_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	075	0		29	10	S5678_075_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	075	0		29	10	S5678_075_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	075	0		29	10	S5678_075_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	075	0		29	10	S5678_075_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	075	0		29	10	S5678_075_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	077	0		29	10	S5678_077_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	077	0		29	10	S5678_077_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	077	0		29	10	S5678_077_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	077	0		29	10	S5678_077_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	077	0		29	10	S5678_077_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	077	0		29	10	S5678_077_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	077	0		29	10	S5678_077_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	077	0		29	10	S5678_077_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	077	0		29	10	S5678_077_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	077	0		29	10	S5678_077_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	078	0		29	10	S5678_078_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	078	0		29	10	S5678_078_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	078	0		29	10	S5678_078_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	078	0		29	10	S5678_078_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	078	0		29	10	S5678_078_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	078	0		29	10	S5678_078_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	078	0		29	10	S5678_078_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	078	0		29	10	S5678_078_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	078	0		29	10	S5678_078_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	078	0		29	10	S5678_078_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	079	0		29	10	S5678_079_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	079	0		29	10	S5678_079_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	079	0		29	10	S5678_079_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	079	0		29	10	S5678_079_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	079	0		29	10	S5678_079_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	079	0		29	10	S5678_079_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	079	0		29	10	S5678_079_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	079	0		29	10	S5678_079_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	079	0		29	10	S5678_079_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	079	0		29	10	S5678_079_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	080	0		29	10	S5678_080_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	080	0		29	10	S5678_080_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	080	0		29	10	S5678_080_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	080	0		29	10	S5678_080_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	080	0		29	10	S5678_080_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	080	0		29	10	S5678_080_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	080	0		29	10	S5678_080_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	080	0		29	10	S5678_080_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	080	0		29	10	S5678_080_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	080	0		29	10	S5678_080_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	081	0		29	10	S5678_081_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	081	0		29	10	S5678_081_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	081	0		29	10	S5678_081_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	081	0		29	10	S5678_081_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	081	0		29	10	S5678_081_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	081	0		29	10	S5678_081_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	081	0		29	10	S5678_081_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	081	0		29	10	S5678_081_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	081	0		29	10	S5678_081_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	081	0		29	10	S5678_081_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	082	0		29	10	S5678_082_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	082	0		29	10	S5678_082_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	082	0		29	10	S5678_082_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	082	0		29	10	S5678_082_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	082	0		29	10	S5678_082_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	082	0		29	10	S5678_082_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	082	0		29	10	S5678_082_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	082	0		29	10	S5678_082_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	082	0		29	10	S5678_082_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	082	0		29	10	S5678_082_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	083	0		29	10	S5678_083_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00								4
S5678	083	0		29	10	S5678_083_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								4
S5678	083	0		29	10	S5678_083_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	083	0		29	10	S5678_083_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	083	0		29	10	S5678_083_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								4
S5678	083	0		29	10	S5678_083_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	083	0		29	10	S5678_083_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00							1	4
S5678	083	0		29	10	S5678_083_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	083	0		29	10	S5678_083_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	083	0		29	10	S5678_083_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	084	0		29	10	S5678_084_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	084	0		29	10	S5678_084_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	084	0		29	10	S5678_084_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	084	0		29	10	S5678_084_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	084	0		29	10	S5678_084_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	084	0		29	10	S5678_084_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	084	0		29	10	S5678_084_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	084	0		29	10	S5678_084_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	084	0		29	10	S5678_084_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	084	0		29	10	S5678_084_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	085	0		29	10	S5678_085_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	085	0		29	10	S5678_085_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	085	0		29	10	S5678_085_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	085	0		29	10	S5678_085_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	085	0		29	10	S5678_085_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	085	0		29	10	S5678_085_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	085	0		29	10	S5678_085_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	085	0		29	10	S5678_085_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	085	0		29	10	S5678_085_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	085	0		29	10	S5678_085_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	086	0		29	10	S5678_086_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	086	0		29	10	S5678_086_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	086	0		29	10	S5678_086_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	086	0		29	10	S5678_086_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	086	0		29	10	S5678_086_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	086	0		29	10	S5678_086_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	086	0		29	10	S5678_086_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	086	0		29	10	S5678_086_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	086	0		29	10	S5678_086_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	086	0		29	10	S5678_086_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	087	0		29	10	S5678_087_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	087	0		29	10	S5678_087_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	087	0		29	10	S5678_087_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	087	0		29	10	S5678_087_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	087	0		29	10	S5678_087_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	087	0		29	10	S5678_087_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	087	0		29	10	S5678_087_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	087	0		29	10	S5678_087_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	087	0		29	10	S5678_087_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	087	0		29	10	S5678_087_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	088	0		29	10	S5678_088_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	088	0		29	10	S5678_088_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	088	0		29	10	S5678_088_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	088	0		29	10	S5678_088_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	088	0		29	10	S5678_088_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	088	0		29	10	S5678_088_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	088	0		29	10	S5678_088_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	088	0		29	10	S5678_088_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	088	0		29	10	S5678_088_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	088	0		29	10	S5678_088_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	089	0		29	10	S5678_089_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	089	0		29	10	S5678_089_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	089	0		29	10	S5678_089_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	089	0		29	10	S5678_089_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	089	0		29	10	S5678_089_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	089	0		29	10	S5678_089_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	089	0		29	10	S5678_089_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	089	0		29	10	S5678_089_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	089	0		29	10	S5678_089_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	089	0		29	10	S5678_089_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	090	0		29	10	S5678_090_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	090	0		29	10	S5678_090_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	090	0		29	10	S5678_090_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	090	0		29	10	S5678_090_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	090	0		29	10	S5678_090_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	090	0		29	10	S5678_090_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	090	0		29	10	S5678_090_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	090	0		29	10	S5678_090_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	090	0		29	10	S5678_090_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	090	0		29	10	S5678_090_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	091	0		29	10	S5678_091_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	091	0		29	10	S5678_091_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	091	0		29	10	S5678_091_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	091	0		29	10	S5678_091_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	091	0		29	10	S5678_091_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	091	0		29	10	S5678_091_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	091	0		29	10	S5678_091_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	091	0		29	10	S5678_091_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	091	0		29	10	S5678_091_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	091	0		29	10	S5678_091_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	092	0		29	10	S5678_092_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	092	0		29	10	S5678_092_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	092	0		29	10	S5678_092_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	092	0		29	10	S5678_092_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	092	0		29	10	S5678_092_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	092	0		29	10	S5678_092_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	092	0		29	10	S5678_092_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	092	0		29	10	S5678_092_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	092	0		29	10	S5678_092_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	092	0		29	10	S5678_092_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	093	0		29	10	S5678_093_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	093	0		29	10	S5678_093_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	093	0		29	10	S5678_093_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	093	0		29	10	S5678_093_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	093	0		29	10	S5678_093_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	093	0		29	10	S5678_093_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	093	0		29	10	S5678_093_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	093	0		29	10	S5678_093_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	093	0		29	10	S5678_093_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	093	0		29	10	S5678_093_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	094	0		29	10	S5678_094_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	094	0		29	10	S5678_094_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	094	0		29	10	S5678_094_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	094	0		29	10	S5678_094_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	094	0		29	10	S5678_094_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	094	0		29	10	S5678_094_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	094	0		29	10	S5678_094_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	094	0		29	10	S5678_094_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	094	0		29	10	S5678_094_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	094	0		29	10	S5678_094_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	095	0		29	10	S5678_095_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	095	0		29	10	S5678_095_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	095	0		29	10	S5678_095_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	095	0		29	10	S5678_095_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	095	0		29	10	S5678_095_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	095	0		29	10	S5678_095_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	095	0		29	10	S5678_095_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	095	0		29	10	S5678_095_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	095	0		29	10	S5678_095_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	095	0		29	10	S5678_095_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	096	0		29	10	S5678_096_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	096	0		29	10	S5678_096_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	096	0		29	10	S5678_096_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	096	0		29	10	S5678_096_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	096	0		29	10	S5678_096_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	096	0		29	10	S5678_096_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	096	0		29	10	S5678_096_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	096	0		29	10	S5678_096_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	096	0		29	10	S5678_096_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	096	0		29	10	S5678_096_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	097	0		29	10	S5678_097_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	097	0		29	10	S5678_097_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	097	0		29	10	S5678_097_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	097	0		29	10	S5678_097_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	097	0		29	10	S5678_097_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	097	0		29	10	S5678_097_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	097	0		29	10	S5678_097_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	097	0		29	10	S5678_097_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	097	0		29	10	S5678_097_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	097	0		29	10	S5678_097_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	098	0		29	10	S5678_098_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00								4
S5678	098	0		29	10	S5678_098_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								4
S5678	098	0		29	10	S5678_098_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	098	0		29	10	S5678_098_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	098	0		29	10	S5678_098_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	098	0		29	10	S5678_098_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	098	0		29	10	S5678_098_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00							1	4
S5678	098	0		29	10	S5678_098_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	098	0		29	10	S5678_098_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	098	0		29	10	S5678_098_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								4
S5678	099	0		29	10	S5678_099_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00								4
S5678	099	0		29	10	S5678_099_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	099	0		29	10	S5678_099_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	099	0		29	10	S5678_099_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	099	0		29	10	S5678_099_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	099	0		29	10	S5678_099_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	099	0		29	10	S5678_099_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	099	0		29	10	S5678_099_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								4
S5678	099	0		29	10	S5678_099_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								4
S5678	099	0		29	10	S5678_099_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00							1	4
S5678	100	0		29	10	S5678_100_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00								4
S5678	100	0		29	10	S5678_100_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								4
S5678	100	0		29	10	S5678_100_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	100	0		29	10	S5678_100_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	100	0		29	10	S5678_100_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								4
S5678	100	0		29	10	S5678_100_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	100	0		29	10	S5678_100_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00							1	4
S5678	100	0		29	10	S5678_100_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	100	0		29	10	S5678_100_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	100	0		29	10	S5678_100_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	101	0		29	10	S5678_101_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	101	0		29	10	S5678_101_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	101	0		29	10	S5678_101_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	101	0		29	10	S5678_101_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	101	0		29	10	S5678_101_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	101	0		29	10	S5678_101_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	101	0		29	10	S5678_101_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	101	0		29	10	S5678_101_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	101	0		29	10	S5678_101_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	101	0		29	10	S5678_101_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	102	0		29	10	S5678_102_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	102	0		29	10	S5678_102_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	102	0		29	10	S5678_102_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00							1	4
S5678	102	0		29	10	S5678_102_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	102	0		29	10	S5678_102_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	60.00	180.00	120.00							60.00	180.00	120.00		150.00	120.00								4
S5678	102	0		29	10	S5678_102_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	102	0		29	10	S5678_102_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5678	102	0		29	10	S5678_102_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	6.50	19.50	13.00							6.50	19.50	13.00		13.00	13.00								4
S5678	102	0		29	10	S5678_102_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	30.00	90.00	60.00							30.00	90.00	60.00		60.00	60.00								4
S5678	102	0		29	10	S5678_102_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	103	0		29	10	S5678_103_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Brand	1	2		011100000011101100000	Preferred Brand																						Preferred Brand	28.00	84.00	56.00							28.00	84.00	56.00		56.00	56.00								4
S5678	103	0		29	10	S5678_103_0	2	3	1	Non-Preferred	100100	1	2	Non-Preferred	011100000011101100000	30	90	60							30	90	60		90	60							Non-Preferred	1	2		011100000011101100000	Non-Preferred																						Non-Preferred	56.00	168.00	112.00							56.00	168.00	112.00		140.00	112.00								4
S5678	103	0		29	10	S5678_103_0	2	4	1	Injectables	010010	1	2	Injectables	011100000011101100000	30	90	60							30	90	60		90	60							Injectables	1	1	011100000011101100000		Injectables	33	33	33							33	33	33		33	33							Injectables																							4
S5678	103	0		29	10	S5678_103_0	2	5	1	Specialty	010010	1	1	Specialty	011100000011101100000	30	90	60							30	90	60		90	60							Specialty	1	1	011100000011101100000		Specialty	33	33	33							33	33	33		33	33							Specialty																							4
S5678	103	0		29	10	S5678_103_0	2	1	3	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00							1	4
S5678	103	0		29	10	S5678_103_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5678	103	0		29	10	S5678_103_0	2	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5678	103	0		29	10	S5678_103_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011100000011101100000	30	90	60							30	90	60		90	60							Preferred Generic	1	2		011100000011101100000	Preferred Generic																						Preferred Generic	7.00	21.00	14.00							7.00	21.00	14.00		14.00	14.00								4
S5678	103	0		29	10	S5678_103_0	2	4	3	Injectables	010010	1	2	Injectables																							Injectables					Injectables																						Injectables																						2	4
S5678	103	0		29	10	S5678_103_0	2	5	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5704	001	0		29	10	S5704_001_0	3	1	1	Formulary Generic	010000		2	Formulary Generic	011000000000101000000	30	90										10		90								Formulary Generic	2	2		011000000000101000000	Formulary Generic																						Formulary Generic	5.00	15.00										5.00		10.00									2
S5704	001	0		29	10	S5704_001_0	3	2	1	Formulary Brand	000010		2	Formulary Brand	011000000000101000000	30	90										10		90								Formulary Brand	2	2		011000000000101000000	Formulary Brand																						Formulary Brand	25.00	75.00										25.00		50.00									2
S5704	001	0		29	10	S5704_001_0	3	3	1	Formulary Specialty	010010		1	Formulary Specialty	011000000000101000000	30	90										10		90								Formulary Specialty	2	1	011000000000101000000		Formulary Specialty	25	25										25		25								Formulary Specialty																							2
S5704	002	0		29	10	S5704_002_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000000101000000	30	90										10		90								Formulary Generic	2	2		011000000000101000000	Formulary Generic																						Formulary Generic	10.00	30.00										10.00		20.00									4
S5704	002	0		29	10	S5704_002_0	4	2	1	Formulary Brand	000001	1	2	Formulary Brand	011000000000101000000	30	90										10		90								Formulary Brand	2	2		011000000000101000000	Formulary Brand																						Formulary Brand	25.00	75.00										25.00		50.00									4
S5704	002	0		29	10	S5704_002_0	4	3	1	Formulary Specialty	010010	1	1	Formulary Specialty	011000000000101000000	30	90										10		90								Formulary Specialty	2	1	011000000000101000000		Formulary Specialty	25	25										25		25								Formulary Specialty																							4
S5715	001	0		29	10	S5715_001_0	2	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-preferred Brand	2	2		000011011010001000000	Non-preferred Brand																						Non-preferred Brand				60.00	120.00		60.00	180.00		60.00				120.00									3
S5715	001	0		29	10	S5715_001_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				40.00	80.00		40.00	120.00		40.00				80.00									3
S5715	001	0		29	10	S5715_001_0	2	1	1	Generic	010000		2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00									3
S5715	001	0		29	10	S5715_001_0	2	4	1	Specialty	010010		1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							3
S5715	002	0		29	10	S5715_002_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	100.00		50.00	150.00		50.00				100.00									4
S5715	002	0		29	10	S5715_002_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				20.00	40.00		20.00	60.00		20.00				40.00									4
S5715	002	0		29	10	S5715_002_0	2	1	1	Generic	010000	1	2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00									4
S5715	002	0		29	10	S5715_002_0	2	4	1	Specialty	010010	1	1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							4
S5715	002	0		29	10	S5715_002_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5715	002	0		29	10	S5715_002_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5715	002	0		29	10	S5715_002_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5715	002	0		29	10	S5715_002_0	2	1	3	Generic	010000	1	2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00								1	4
S5715	003	0		29	10	S5715_003_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				40.00	80.00		40.00	120.00		40.00				80.00									3
S5715	003	0		29	10	S5715_003_0	2	1	1	Generic	010000		2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00									3
S5715	003	0		29	10	S5715_003_0	2	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-preferred Brand	2	2		000011011010001000000	Non-preferred Brand																						Non-preferred Brand				60.00	120.00		60.00	180.00		60.00				120.00									3
S5715	003	0		29	10	S5715_003_0	2	4	1	Specialty	010010		1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							3
S5715	004	0		29	10	S5715_004_0	2	1	1	Generic	010000	1	2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00									4
S5715	004	0		29	10	S5715_004_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				20.00	40.00		20.00	60.00		20.00				40.00									4
S5715	004	0		29	10	S5715_004_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5715	004	0		29	10	S5715_004_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5715	004	0		29	10	S5715_004_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5715	004	0		29	10	S5715_004_0	2	1	3	Generic	010000	1	2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00								1	4
S5715	004	0		29	10	S5715_004_0	2	4	1	Specialty	010010	1	1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							4
S5715	004	0		29	10	S5715_004_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	100.00		50.00	150.00		50.00				100.00									4
S5715	005	0		29	10	S5715_005_0	2	3	1	Non-preferred Brand	100000		2	Non-preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-preferred Brand	2	2		000011011010001000000	Non-preferred Brand																						Non-preferred Brand				60.00	120.00		60.00	180.00		60.00				120.00									3
S5715	005	0		29	10	S5715_005_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				40.00	80.00		40.00	120.00		40.00				80.00									3
S5715	005	0		29	10	S5715_005_0	2	1	1	Generic	010000		2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00									3
S5715	005	0		29	10	S5715_005_0	2	4	1	Specialty	010010		1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							3
S5715	006	0		29	10	S5715_006_0	2	4	1	Specialty	010010	1	1	Specialty	000011011010000000000				30	90		30	90		30												Specialty	2	1	000011011010000000000		Specialty				25	25		25	25		25												Specialty																							4
S5715	006	0		29	10	S5715_006_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011011010001000000				30	90		30	90		30				90								Non-Preferred Brand	2	2		000011011010001000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	100.00		50.00	150.00		50.00				100.00									4
S5715	006	0		29	10	S5715_006_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011011010001000000				30	90		30	90		30				90								Preferred Brand	2	2		000011011010001000000	Preferred Brand																						Preferred Brand				20.00	40.00		20.00	60.00		20.00				40.00									4
S5715	006	0		29	10	S5715_006_0	2	1	3	Generic	010000	1	2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00								1	4
S5715	006	0		29	10	S5715_006_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5715	006	0		29	10	S5715_006_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5715	006	0		29	10	S5715_006_0	2	1	1	Generic	010000	1	2	Generic	000011011010001000000				30	90		30	90		30				90								Generic	2	2		000011011010001000000	Generic																						Generic				5.00	10.00		5.00	15.00		5.00				10.00									4
S5715	006	0		29	10	S5715_006_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5726	013	0		29	10	S5726_013_0	4	4	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							3
S5726	013	0		29	10	S5726_013_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			3
S5726	013	0		29	10	S5726_013_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	27.00	81.00								27.00							67.50			81.00			3
S5726	013	0		29	10	S5726_013_0	4	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			3
S5726	013	0		29	10	S5726_013_0	4	5	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							3
S5726	014	0		29	10	S5726_014_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5726	014	0		29	10	S5726_014_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5726	014	0		29	10	S5726_014_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5726	014	0		29	10	S5726_014_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5726	014	0		29	10	S5726_014_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5726	015	0		29	10	S5726_015_0	5	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5726	015	0		29	10	S5726_015_0	5	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5726	015	0		29	10	S5726_015_0	5	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5726	015	0		29	10	S5726_015_0	5	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5726	015	0		29	10	S5726_015_0	5	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5726	015	0		29	10	S5726_015_0	5	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5726	015	0		29	10	S5726_015_0	5	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5726	015	0		29	10	S5726_015_0	5	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5726	015	0		29	10	S5726_015_0	5	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5726	015	0		29	10	S5726_015_0	5	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5741	001	0		29	10	S5741_001_0	7	1	1	Tier 1	001000		2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				5.00	7.50	10.00	5.00	15.00	10.00	5.00			2.50	7.50	5.00								2
S5741	001	0		29	10	S5741_001_0	7	4	1	Tier 4	010010		1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							2
S5741	001	0		29	10	S5741_001_0	7	3	1	Tier 3	100100		2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				40	40	40	40	40	40	40			40	40	40							Tier 3																							2
S5741	001	0		29	10	S5741_001_0	7	2	1	Tier 2	000001		2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	1	000011111110011100000		Tier 2				25	25	25	25	25	25	25			25	25	25							Tier 2																							2
S5741	003	0		29	10	S5741_003_0	7	1	3	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00							1	4
S5741	003	0		29	10	S5741_003_0	7	4	1	Tier 4	010010	1	1	Tier 4	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 4	2	1	000011111110011100000		Tier 4				25	25	25	25	25	25	25			25	25	25							Tier 4																							4
S5741	003	0		29	10	S5741_003_0	7	3	1	Tier 3	100100	1	2	Tier 3	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 3	2	1	000011111110011100000		Tier 3				50	50	50	50	50	50	50			50	50	50							Tier 3																							4
S5741	003	0		29	10	S5741_003_0	7	2	1	Tier 2	000001	1	2	Tier 2	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 2	2	2		000011111110011100000	Tier 2																						Tier 2				20.00	30.00	40.00	20.00	60.00	40.00	20.00			10.00	30.00	20.00								4
S5741	003	0		29	10	S5741_003_0	7	1	1	Tier 1	001000	1	2	Tier 1	000011111110011100000				30	90	60	30	90	60	30			30	90	60							Tier 1	2	2		000011111110011100000	Tier 1																						Tier 1				10.00	15.00	20.00	10.00	30.00	20.00	10.00			5.00	15.00	10.00								4
S5741	003	0		29	10	S5741_003_0	7	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5741	003	0		29	10	S5741_003_0	7	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5741	003	0		29	10	S5741_003_0	7	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5743	003	0		29	10	S5743_003_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				10.00									4
S5743	003	0		29	10	S5743_003_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00				40.00									4
S5743	003	0		29	10	S5743_003_0	2	3	1	Brand	100000	1	2	Brand	011000000010001000000	31	90								31				90								Brand	2	1	011000000010001000000		Brand	50	50								50				50								Brand																							4
S5743	003	0		29	10	S5743_003_0	2	4	1	Specialty	010010	1	1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							4
S5743	004	0		29	10	S5743_004_0	1	1	1	Generic	010000	1	2	Generic	011000000010001000000	31	90								31				90								Generic	2	1	011000000010001000000		Generic	30	30								30				30								Generic																							4
S5743	004	0		29	10	S5743_004_0	1	3	1	Brand	100000	1	2	Brand	011000000010001000000	31	90								31				90								Brand	2	1	011000000010001000000		Brand	30	30								30				30								Brand																							4
S5743	004	0		29	10	S5743_004_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	1	011000000010001000000		Preferred Brand	30	30								30				30								Preferred Brand																							4
S5743	004	0		29	10	S5743_004_0	1	4	1	Specialty	010010	1	1	Specialty	011000000010001000000	31	90								31				90								Specialty	2	1	011000000010001000000		Specialty	30	30								30				30								Specialty																							4
S5753	006	0		29	10	S5753_006_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011100000011111000000	30	90	60							30	90	60	30	90								Preferred Brand	2	2		011100000011111000000	Preferred Brand																						Preferred Brand	37.00	111.00	74.00							37.00	111.00	74.00	37.00	74.00									3
S5753	006	0		29	10	S5753_006_0	3	1	1	Generic	010000		2	Generic	011100000011111000000	30	90	60							30	90	60	30	90								Generic	2	2		011100000011111000000	Generic																						Generic	6.00	18.00	12.00							6.00	18.00	12.00	6.00	12.00									3
S5753	006	0		29	10	S5753_006_0	3	4	1	Specialty Brand	000010		1	Specialty Brand	011000000011011000000	30	90								30	90		30	90								Specialty Brand	2	1	011000000011011000000		Specialty Brand	33	33								33	33		33	33								Specialty Brand																							3
S5753	006	0		29	10	S5753_006_0	3	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011100000011111000000	30	90	60							30	90	60	30	90								Non-Preferred Brand	2	2		011100000011111000000	Non-Preferred Brand																						Non-Preferred Brand	57.00	171.00	114.00							57.00	171.00	114.00	57.00	114.00									3
S5753	007	0		29	10	S5753_007_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5753	007	0		29	10	S5753_007_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5753	007	0		29	10	S5753_007_0	4	4	3	Specialty Brand	000010	1	1	Specialty Brand																							Specialty Brand					Specialty Brand																						Specialty Brand																						2	4
S5753	007	0		29	10	S5753_007_0	4	4	1	Specialty Brand	000010	1	1	Specialty Brand	011000000011011000000	30	90								30	90		30	90								Specialty Brand	2	1	011000000011011000000		Specialty Brand	33	33								33	33		33	33								Specialty Brand																							4
S5753	007	0		29	10	S5753_007_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011100000011111000000	30	90	60							30	90	60	30	90								Non-Preferred Brand	2	2		011100000011111000000	Non-Preferred Brand																						Non-Preferred Brand	57.00	171.00	114.00							57.00	171.00	114.00	57.00	114.00									4
S5753	007	0		29	10	S5753_007_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011100000011111000000	30	90	60							30	90	60	30	90								Preferred Brand	2	2		011100000011111000000	Preferred Brand																						Preferred Brand	37.00	111.00	74.00							37.00	111.00	74.00	37.00	74.00									4
S5753	007	0		29	10	S5753_007_0	4	1	1	Generic	010000	1	2	Generic	011100000011111000000	30	90	60							30	90	60	30	90								Generic	2	2		011100000011111000000	Generic																						Generic	6.00	18.00	12.00							6.00	18.00	12.00	6.00	12.00									4
S5753	007	0		29	10	S5753_007_0	4	1	3	Generic	010000	1	2	Generic	011100000011111000000	30	90	60							30	90	60	30	90								Generic	2	2		011100000011111000000	Generic																						Generic	6.00	18.00	12.00							6.00	18.00	12.00	6.00	12.00								1	4
S5755	005	0		29	10	S5755_005_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	005	0		29	10	S5755_005_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	005	0		29	10	S5755_005_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	005	0		29	10	S5755_005_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	006	0		29	10	S5755_006_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	006	0		29	10	S5755_006_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	006	0		29	10	S5755_006_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	006	0		29	10	S5755_006_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	007	0		29	10	S5755_007_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	007	0		29	10	S5755_007_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	007	0		29	10	S5755_007_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	007	0		29	10	S5755_007_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	008	0		29	10	S5755_008_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	008	0		29	10	S5755_008_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	008	0		29	10	S5755_008_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	008	0		29	10	S5755_008_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	009	0		29	10	S5755_009_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	009	0		29	10	S5755_009_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	009	0		29	10	S5755_009_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	009	0		29	10	S5755_009_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	010	0		29	10	S5755_010_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	010	0		29	10	S5755_010_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	010	0		29	10	S5755_010_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	010	0		29	10	S5755_010_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	011	0		29	10	S5755_011_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	011	0		29	10	S5755_011_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	011	0		29	10	S5755_011_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	011	0		29	10	S5755_011_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	012	0		29	10	S5755_012_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	012	0		29	10	S5755_012_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	012	0		29	10	S5755_012_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	012	0		29	10	S5755_012_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	013	0		29	10	S5755_013_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	013	0		29	10	S5755_013_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	013	0		29	10	S5755_013_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	013	0		29	10	S5755_013_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	014	0		29	10	S5755_014_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	014	0		29	10	S5755_014_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	014	0		29	10	S5755_014_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	014	0		29	10	S5755_014_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	015	0		29	10	S5755_015_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	015	0		29	10	S5755_015_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	015	0		29	10	S5755_015_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	015	0		29	10	S5755_015_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	016	0		29	10	S5755_016_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	016	0		29	10	S5755_016_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	016	0		29	10	S5755_016_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	016	0		29	10	S5755_016_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	017	0		29	10	S5755_017_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	017	0		29	10	S5755_017_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	017	0		29	10	S5755_017_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	017	0		29	10	S5755_017_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	018	0		29	10	S5755_018_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	018	0		29	10	S5755_018_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	018	0		29	10	S5755_018_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	018	0		29	10	S5755_018_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	019	0		29	10	S5755_019_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	019	0		29	10	S5755_019_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	019	0		29	10	S5755_019_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	019	0		29	10	S5755_019_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	020	0		29	10	S5755_020_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	020	0		29	10	S5755_020_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	020	0		29	10	S5755_020_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	020	0		29	10	S5755_020_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	021	0		29	10	S5755_021_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	021	0		29	10	S5755_021_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	021	0		29	10	S5755_021_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	021	0		29	10	S5755_021_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	022	0		29	10	S5755_022_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	022	0		29	10	S5755_022_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	022	0		29	10	S5755_022_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	022	0		29	10	S5755_022_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	023	0		29	10	S5755_023_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	023	0		29	10	S5755_023_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	023	0		29	10	S5755_023_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	023	0		29	10	S5755_023_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	024	0		29	10	S5755_024_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	024	0		29	10	S5755_024_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	024	0		29	10	S5755_024_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	024	0		29	10	S5755_024_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	025	0		29	10	S5755_025_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	025	0		29	10	S5755_025_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	025	0		29	10	S5755_025_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	025	0		29	10	S5755_025_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	026	0		29	10	S5755_026_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	026	0		29	10	S5755_026_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	026	0		29	10	S5755_026_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	026	0		29	10	S5755_026_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	027	0		29	10	S5755_027_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	027	0		29	10	S5755_027_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	027	0		29	10	S5755_027_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	027	0		29	10	S5755_027_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	028	0		29	10	S5755_028_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	028	0		29	10	S5755_028_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	028	0		29	10	S5755_028_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	028	0		29	10	S5755_028_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	029	0		29	10	S5755_029_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	029	0		29	10	S5755_029_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	029	0		29	10	S5755_029_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	029	0		29	10	S5755_029_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	030	0		29	10	S5755_030_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	030	0		29	10	S5755_030_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	030	0		29	10	S5755_030_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	030	0		29	10	S5755_030_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	031	0		29	10	S5755_031_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	031	0		29	10	S5755_031_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	031	0		29	10	S5755_031_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	031	0		29	10	S5755_031_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	032	0		29	10	S5755_032_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	032	0		29	10	S5755_032_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	032	0		29	10	S5755_032_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	032	0		29	10	S5755_032_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	033	0		29	10	S5755_033_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	033	0		29	10	S5755_033_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	033	0		29	10	S5755_033_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	033	0		29	10	S5755_033_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	034	0		29	10	S5755_034_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	034	0		29	10	S5755_034_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	034	0		29	10	S5755_034_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	034	0		29	10	S5755_034_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	035	0		29	10	S5755_035_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	035	0		29	10	S5755_035_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	035	0		29	10	S5755_035_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	035	0		29	10	S5755_035_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	038	0		29	10	S5755_038_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	038	0		29	10	S5755_038_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5755	038	0		29	10	S5755_038_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	038	0		29	10	S5755_038_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	039	0		29	10	S5755_039_0	1	1	1	Generic	010000	1	2	Generic	011000000000101000000	34	90										15		90								Generic	2	2		011000000000101000000	Generic																						Generic	9.00	18.00										9.00		18.00									4
S5755	039	0		29	10	S5755_039_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000000101000000	34	90										15		90								Preferred Brand	2	2		011000000000101000000	Preferred Brand																						Preferred Brand	30.00	60.00										30.00		60.00									4
S5755	039	0		29	10	S5755_039_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000000101000000	34	90										15		90								Non-Preferred Brand	2	2		011000000000101000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00										60.00		120.00									4
S5755	039	0		29	10	S5755_039_0	1	4	1	Specialty	100000	1	1	Specialty	011000000000101000000	34	90										15		90								Specialty	2	1	011000000000101000000		Specialty	33	33										33		33								Specialty																							4
S5766	002	0		29	10	S5766_002_0	3	1	1	Generic	010000		2	Generic	011000000011000000000	34	90								34	90											Generic	2	2		011000000011000000000	Generic																						Generic	7.00	14.00								7.00	14.00												3
S5766	002	0		29	10	S5766_002_0	3	4	1	Non Self-Administered Medical Injectables	010010		2	Non Self-Administered Medical Injectables	011000000011000000000	34	90								34	90											Non Self-Administered Medical Injectables	2	1	011000000011000000000		Non Self-Administered Medical Injectables	25	25								25	25											Non Self-Administered Medical Injectables																							3
S5766	002	0		29	10	S5766_002_0	3	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011000000000	34	90								34	90											Non-Preferred Brand	2	2		011000000011000000000	Non-Preferred Brand																						Non-Preferred Brand	69.00	138.00								69.00	138.00												3
S5766	002	0		29	10	S5766_002_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011000000000	34	90								34	90											Preferred Brand	2	2		011000000011000000000	Preferred Brand																						Preferred Brand	25.00	50.00								25.00	50.00												3
S5766	003	0		29	10	S5766_003_0	3	1	1	Generic	010000	1	2	Generic	011000000011000000000	34	90								34	90											Generic	2	2		011000000011000000000	Generic																						Generic	7.00	14.00								7.00	14.00												4
S5766	003	0		29	10	S5766_003_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011000000000	34	90								34	90											Preferred Brand	2	2		011000000011000000000	Preferred Brand																						Preferred Brand	25.00	50.00								25.00	50.00												4
S5766	003	0		29	10	S5766_003_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011000000000	34	90								34	90											Non-Preferred Brand	2	2		011000000011000000000	Non-Preferred Brand																						Non-Preferred Brand	69.00	138.00								69.00	138.00												4
S5766	003	0		29	10	S5766_003_0	3	4	1	Non Self-Administered Medical Injectables	010010	1	2	Non Self-Administered Medical Injectables	011000000011000000000	34	90								34	90											Non Self-Administered Medical Injectables	2	1	011000000011000000000		Non Self-Administered Medical Injectables	25	25								25	25											Non Self-Administered Medical Injectables																							4
S5766	003	0		29	10	S5766_003_0	3	1	3	Generic	010000	1	2	Generic	011000000011000000000	34	90								34	90											Generic	2	2		011000000011000000000	Generic																						Generic	7.00	14.00								7.00	14.00											1	4
S5766	003	0		29	10	S5766_003_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5766	003	0		29	10	S5766_003_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5766	003	0		29	10	S5766_003_0	3	4	3	Non Self-Administered Medical Injectables	010010	1	2	Non Self-Administered Medical Injectables																							Non Self-Administered Medical Injectables					Non Self-Administered Medical Injectables																						Non Self-Administered Medical Injectables																						2	4
S5768	005	0		29	10	S5768_005_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00													3
S5768	005	0		29	10	S5768_005_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	005	0		29	10	S5768_005_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	005	0		29	10	S5768_005_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	007	0		29	10	S5768_007_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00													3
S5768	007	0		29	10	S5768_007_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	007	0		29	10	S5768_007_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	007	0		29	10	S5768_007_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	008	0		29	10	S5768_008_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	008	0		29	10	S5768_008_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	008	0		29	10	S5768_008_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	58.00	174.00								58.00													3
S5768	008	0		29	10	S5768_008_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	009	0		29	10	S5768_009_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	009	0		29	10	S5768_009_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	009	0		29	10	S5768_009_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	58.00	174.00								58.00													3
S5768	009	0		29	10	S5768_009_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	010	0		29	10	S5768_010_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00													3
S5768	010	0		29	10	S5768_010_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	010	0		29	10	S5768_010_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	010	0		29	10	S5768_010_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	012	0		29	10	S5768_012_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	012	0		29	10	S5768_012_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	012	0		29	10	S5768_012_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	68.00	204.00								68.00													3
S5768	012	0		29	10	S5768_012_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	015	0		29	10	S5768_015_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00													3
S5768	015	0		29	10	S5768_015_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	015	0		29	10	S5768_015_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	015	0		29	10	S5768_015_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	016	0		29	10	S5768_016_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	016	0		29	10	S5768_016_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	016	0		29	10	S5768_016_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	47.00	141.00								47.00													3
S5768	016	0		29	10	S5768_016_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	017	0		29	10	S5768_017_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	017	0		29	10	S5768_017_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	017	0		29	10	S5768_017_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	017	0		29	10	S5768_017_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00													3
S5768	018	0		29	10	S5768_018_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	018	0		29	10	S5768_018_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00													3
S5768	018	0		29	10	S5768_018_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	018	0		29	10	S5768_018_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	021	0		29	10	S5768_021_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	021	0		29	10	S5768_021_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	021	0		29	10	S5768_021_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	54.00	162.00								54.00													3
S5768	021	0		29	10	S5768_021_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	031	0		29	10	S5768_031_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	031	0		29	10	S5768_031_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	031	0		29	10	S5768_031_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	65.00	195.00								65.00													3
S5768	031	0		29	10	S5768_031_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	038	0		29	10	S5768_038_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	038	0		29	10	S5768_038_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	038	0		29	10	S5768_038_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	038	0		29	10	S5768_038_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	51.00	153.00								51.00													3
S5768	039	0		29	10	S5768_039_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	039	0		29	10	S5768_039_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	62.00	186.00								62.00													3
S5768	039	0		29	10	S5768_039_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	039	0		29	10	S5768_039_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	040	0		29	10	S5768_040_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	040	0		29	10	S5768_040_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	040	0		29	10	S5768_040_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	46.00	138.00								46.00													3
S5768	040	0		29	10	S5768_040_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	041	0		29	10	S5768_041_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	041	0		29	10	S5768_041_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	041	0		29	10	S5768_041_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	60.00	180.00								60.00													3
S5768	041	0		29	10	S5768_041_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	042	0		29	10	S5768_042_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	042	0		29	10	S5768_042_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	042	0		29	10	S5768_042_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	042	0		29	10	S5768_042_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00													3
S5768	043	0		29	10	S5768_043_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	043	0		29	10	S5768_043_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	043	0		29	10	S5768_043_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	62.00	186.00								62.00													3
S5768	043	0		29	10	S5768_043_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	044	0		29	10	S5768_044_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	044	0		29	10	S5768_044_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	60.00	180.00								60.00													3
S5768	044	0		29	10	S5768_044_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	044	0		29	10	S5768_044_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	045	0		29	10	S5768_045_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	045	0		29	10	S5768_045_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	045	0		29	10	S5768_045_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	045	0		29	10	S5768_045_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	70.00	210.00								70.00													3
S5768	046	0		29	10	S5768_046_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	046	0		29	10	S5768_046_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	046	0		29	10	S5768_046_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	63.00	189.00								63.00													3
S5768	046	0		29	10	S5768_046_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	047	0		29	10	S5768_047_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	047	0		29	10	S5768_047_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	047	0		29	10	S5768_047_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00													3
S5768	047	0		29	10	S5768_047_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	048	0		29	10	S5768_048_0	2	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	048	0		29	10	S5768_048_0	2	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													3
S5768	048	0		29	10	S5768_048_0	2	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	048	0		29	10	S5768_048_0	2	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00													3
S5768	049	0		29	10	S5768_049_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	049	0		29	10	S5768_049_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													4
S5768	049	0		29	10	S5768_049_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	44.00	132.00								44.00													4
S5768	049	0		29	10	S5768_049_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	049	0		29	10	S5768_049_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	049	0		29	10	S5768_049_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	049	0		29	10	S5768_049_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	049	0		29	10	S5768_049_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	050	0		29	10	S5768_050_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	050	0		29	10	S5768_050_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	21.00	63.00								21.00													4
S5768	050	0		29	10	S5768_050_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	050	0		29	10	S5768_050_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	050	0		29	10	S5768_050_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	050	0		29	10	S5768_050_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	050	0		29	10	S5768_050_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	050	0		29	10	S5768_050_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	51.00	153.00								51.00													4
S5768	051	0		29	10	S5768_051_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	051	0		29	10	S5768_051_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	051	0		29	10	S5768_051_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	6.00	18.00								6.00													4
S5768	051	0		29	10	S5768_051_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													4
S5768	051	0		29	10	S5768_051_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00													4
S5768	051	0		29	10	S5768_051_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	051	0		29	10	S5768_051_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	051	0		29	10	S5768_051_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	052	0		29	10	S5768_052_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	052	0		29	10	S5768_052_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	052	0		29	10	S5768_052_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	052	0		29	10	S5768_052_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	23.00	69.00								23.00													4
S5768	052	0		29	10	S5768_052_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	55.00	165.00								55.00													4
S5768	052	0		29	10	S5768_052_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	052	0		29	10	S5768_052_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	052	0		29	10	S5768_052_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	053	0		29	10	S5768_053_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00													4
S5768	053	0		29	10	S5768_053_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	21.00	63.00								21.00													4
S5768	053	0		29	10	S5768_053_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	053	0		29	10	S5768_053_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	053	0		29	10	S5768_053_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	053	0		29	10	S5768_053_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	053	0		29	10	S5768_053_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	053	0		29	10	S5768_053_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	054	0		29	10	S5768_054_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	53.00	159.00								53.00													4
S5768	054	0		29	10	S5768_054_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00													4
S5768	054	0		29	10	S5768_054_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	054	0		29	10	S5768_054_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	054	0		29	10	S5768_054_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	054	0		29	10	S5768_054_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	054	0		29	10	S5768_054_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	054	0		29	10	S5768_054_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	055	0		29	10	S5768_055_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	055	0		29	10	S5768_055_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	055	0		29	10	S5768_055_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00													4
S5768	055	0		29	10	S5768_055_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	055	0		29	10	S5768_055_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	055	0		29	10	S5768_055_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	055	0		29	10	S5768_055_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													4
S5768	055	0		29	10	S5768_055_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	056	0		29	10	S5768_056_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	056	0		29	10	S5768_056_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	056	0		29	10	S5768_056_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	056	0		29	10	S5768_056_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	056	0		29	10	S5768_056_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	056	0		29	10	S5768_056_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	21.00	63.00								21.00													4
S5768	056	0		29	10	S5768_056_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	51.00	153.00								51.00													4
S5768	056	0		29	10	S5768_056_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	057	0		29	10	S5768_057_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	21.00	63.00								21.00													4
S5768	057	0		29	10	S5768_057_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	057	0		29	10	S5768_057_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	41.00	123.00								41.00													4
S5768	057	0		29	10	S5768_057_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	057	0		29	10	S5768_057_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	057	0		29	10	S5768_057_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	057	0		29	10	S5768_057_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	057	0		29	10	S5768_057_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	058	0		29	10	S5768_058_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00													4
S5768	058	0		29	10	S5768_058_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	6.00	18.00								6.00													4
S5768	058	0		29	10	S5768_058_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	058	0		29	10	S5768_058_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	058	0		29	10	S5768_058_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	058	0		29	10	S5768_058_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	058	0		29	10	S5768_058_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	058	0		29	10	S5768_058_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	48.00	144.00								48.00													4
S5768	059	0		29	10	S5768_059_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	059	0		29	10	S5768_059_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	059	0		29	10	S5768_059_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	059	0		29	10	S5768_059_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	059	0		29	10	S5768_059_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	059	0		29	10	S5768_059_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	51.00	153.00								51.00													4
S5768	059	0		29	10	S5768_059_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													4
S5768	059	0		29	10	S5768_059_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	060	0		29	10	S5768_060_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	060	0		29	10	S5768_060_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													4
S5768	060	0		29	10	S5768_060_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	060	0		29	10	S5768_060_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	060	0		29	10	S5768_060_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	060	0		29	10	S5768_060_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	060	0		29	10	S5768_060_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	060	0		29	10	S5768_060_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00													4
S5768	061	0		29	10	S5768_061_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	061	0		29	10	S5768_061_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	061	0		29	10	S5768_061_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	061	0		29	10	S5768_061_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	061	0		29	10	S5768_061_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	061	0		29	10	S5768_061_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00													4
S5768	061	0		29	10	S5768_061_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													4
S5768	061	0		29	10	S5768_061_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	062	0		29	10	S5768_062_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	062	0		29	10	S5768_062_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	21.00	63.00								21.00													4
S5768	062	0		29	10	S5768_062_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00													4
S5768	062	0		29	10	S5768_062_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	062	0		29	10	S5768_062_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	062	0		29	10	S5768_062_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	062	0		29	10	S5768_062_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	062	0		29	10	S5768_062_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	063	0		29	10	S5768_063_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	063	0		29	10	S5768_063_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	45	45								45												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	063	0		29	10	S5768_063_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	26.00	78.00								26.00													3
S5768	063	0		29	10	S5768_063_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	064	0		29	10	S5768_064_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	064	0		29	10	S5768_064_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	064	0		29	10	S5768_064_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	064	0		29	10	S5768_064_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	064	0		29	10	S5768_064_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	21.00	63.00								21.00													4
S5768	064	0		29	10	S5768_064_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	53.00	159.00								53.00													4
S5768	064	0		29	10	S5768_064_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	064	0		29	10	S5768_064_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	065	0		29	10	S5768_065_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	065	0		29	10	S5768_065_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	065	0		29	10	S5768_065_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	065	0		29	10	S5768_065_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	065	0		29	10	S5768_065_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													4
S5768	065	0		29	10	S5768_065_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	065	0		29	10	S5768_065_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	065	0		29	10	S5768_065_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	50.00	150.00								50.00													4
S5768	066	0		29	10	S5768_066_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	066	0		29	10	S5768_066_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	066	0		29	10	S5768_066_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	066	0		29	10	S5768_066_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	066	0		29	10	S5768_066_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	066	0		29	10	S5768_066_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	51.00	153.00								51.00													4
S5768	066	0		29	10	S5768_066_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													4
S5768	066	0		29	10	S5768_066_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	067	0		29	10	S5768_067_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	45	45								45												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	067	0		29	10	S5768_067_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	24.00	72.00								24.00													3
S5768	067	0		29	10	S5768_067_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	067	0		29	10	S5768_067_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	068	0		29	10	S5768_068_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	068	0		29	10	S5768_068_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	068	0		29	10	S5768_068_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	21.00	63.00								21.00													4
S5768	068	0		29	10	S5768_068_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00													4
S5768	068	0		29	10	S5768_068_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	068	0		29	10	S5768_068_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	068	0		29	10	S5768_068_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	068	0		29	10	S5768_068_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	069	0		29	10	S5768_069_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	069	0		29	10	S5768_069_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	069	0		29	10	S5768_069_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	54.00	162.00								54.00													4
S5768	069	0		29	10	S5768_069_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	069	0		29	10	S5768_069_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	069	0		29	10	S5768_069_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	069	0		29	10	S5768_069_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	069	0		29	10	S5768_069_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00													4
S5768	070	0		29	10	S5768_070_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	070	0		29	10	S5768_070_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00													4
S5768	070	0		29	10	S5768_070_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	53.00	159.00								53.00													4
S5768	070	0		29	10	S5768_070_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	070	0		29	10	S5768_070_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	070	0		29	10	S5768_070_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	070	0		29	10	S5768_070_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	070	0		29	10	S5768_070_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	071	0		29	10	S5768_071_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	071	0		29	10	S5768_071_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	071	0		29	10	S5768_071_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	071	0		29	10	S5768_071_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	071	0		29	10	S5768_071_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	071	0		29	10	S5768_071_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													4
S5768	071	0		29	10	S5768_071_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	071	0		29	10	S5768_071_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	52.00	156.00								52.00													4
S5768	072	0		29	10	S5768_072_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	21.00	63.00								21.00													3
S5768	072	0		29	10	S5768_072_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	50	50								50												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	072	0		29	10	S5768_072_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	072	0		29	10	S5768_072_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	073	0		29	10	S5768_073_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	073	0		29	10	S5768_073_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	073	0		29	10	S5768_073_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	073	0		29	10	S5768_073_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	073	0		29	10	S5768_073_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	27.00	81.00								27.00													4
S5768	073	0		29	10	S5768_073_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	073	0		29	10	S5768_073_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	47.00	141.00								47.00													4
S5768	073	0		29	10	S5768_073_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													4
S5768	074	0		29	10	S5768_074_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	45	45								45												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	074	0		29	10	S5768_074_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	074	0		29	10	S5768_074_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	24.00	72.00								24.00													3
S5768	074	0		29	10	S5768_074_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	6.00	18.00								6.00													3
S5768	075	0		29	10	S5768_075_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	6.00	18.00								6.00													3
S5768	075	0		29	10	S5768_075_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													3
S5768	075	0		29	10	S5768_075_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	50	50								50												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	075	0		29	10	S5768_075_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	076	0		29	10	S5768_076_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5768	076	0		29	10	S5768_076_0	4	3	3	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand																							Non-Preferred Generic/Non-Preferred Brand					Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand																						2	4
S5768	076	0		29	10	S5768_076_0	4	4	3	Specialty Drugs	010010	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5768	076	0		29	10	S5768_076_0	4	1	3	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	22.00	66.00								22.00												1	4
S5768	076	0		29	10	S5768_076_0	4	4	1	Specialty Drugs	010010	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							4
S5768	076	0		29	10	S5768_076_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100	1	2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	2		011000000010000000000	Non-Preferred Generic/Non-Preferred Brand																						Non-Preferred Generic/Non-Preferred Brand	57.00	171.00								57.00													4
S5768	076	0		29	10	S5768_076_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00													4
S5768	076	0		29	10	S5768_076_0	4	1	1	Preferred Generic	001001	1	2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	6.00	18.00								6.00													4
S5768	077	0		29	10	S5768_077_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	077	0		29	10	S5768_077_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00													3
S5768	077	0		29	10	S5768_077_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	50	50								50												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	077	0		29	10	S5768_077_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	078	0		29	10	S5768_078_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	50	50								50												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	078	0		29	10	S5768_078_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	078	0		29	10	S5768_078_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	078	0		29	10	S5768_078_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00													3
S5768	079	0		29	10	S5768_079_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	50	50								50												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	079	0		29	10	S5768_079_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	079	0		29	10	S5768_079_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00													3
S5768	079	0		29	10	S5768_079_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	080	0		29	10	S5768_080_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	080	0		29	10	S5768_080_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	23.00	69.00								23.00													3
S5768	080	0		29	10	S5768_080_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	50	50								50												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	080	0		29	10	S5768_080_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5768	081	0		29	10	S5768_081_0	4	1	1	Preferred Generic	001001		2	Preferred Generic	011000000010000000000	30	90								30												Preferred Generic	1	2		011000000010000000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00													3
S5768	081	0		29	10	S5768_081_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	1	2		011000000010000000000	Preferred Brand																						Preferred Brand	24.00	72.00								24.00													3
S5768	081	0		29	10	S5768_081_0	4	3	1	Non-Preferred Generic/Non-Preferred Brand	100100		2	Non-Preferred Generic/Non-Preferred Brand	011000000010000000000	30	90								30												Non-Preferred Generic/Non-Preferred Brand	1	1	011000000010000000000		Non-Preferred Generic/Non-Preferred Brand	50	50								50												Non-Preferred Generic/Non-Preferred Brand																							3
S5768	081	0		29	10	S5768_081_0	4	4	1	Specialty Drugs	010010		1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	1	1	011000000010000000000		Specialty Drugs	25	25								25												Specialty Drugs																							3
S5775	001	0		29	10	S5775_001_0	7	3	1	Tier 3	100000	1	2	Tier 3	011011011010000000000	30	90		30	90		30	90		30												Tier 3	2	2		011011011010000000000	Tier 3																						Tier 3	50.00	150.00		50.00	150.00		50.00	150.00		50.00													4
S5775	001	0		29	10	S5775_001_0	7	2	1	Tier 2	000001	1	2	Tier 2	011011011010000000000	30	90		30	90		30	90		30												Tier 2	2	2		011011011010000000000	Tier 2																						Tier 2	25.00	75.00		25.00	75.00		25.00	75.00		25.00													4
S5775	001	0		29	10	S5775_001_0	7	1	1	Tier 1	010000	1	2	Tier 1	011011011010000000000	30	90		30	90		30	90		30												Tier 1	2	2		011011011010000000000	Tier 1																						Tier 1	3.00	9.00		3.00	9.00		3.00	9.00		3.00													4
S5775	001	0		29	10	S5775_001_0	7	4	1	Tier 4	100011	1	1	Tier 4	011011011010000000000	30	90		30	90		30	90		30												Tier 4	2	1	011011011010000000000		Tier 4	25	25		25	25		25	25		25												Tier 4																							4
S5775	002	0		29	10	S5775_002_0	10	3	1	tier 3	100000		2	tier 3	011011011010000000000	30	90		30	90		30	90		30												tier 3	2	2		011011011010000000000	tier 3																						tier 3	65.00	195.00		65.00	195.00		65.00	195.00		65.00													3
S5775	002	0		29	10	S5775_002_0	10	2	1	tier 2	000001		2	tier 2	011011011010000000000	30	90		30	90		30	90		30												tier 2	2	2		011011011010000000000	tier 2																						tier 2	33.00	99.00		33.00	99.00		33.00	99.00		33.00													3
S5775	002	0		29	10	S5775_002_0	10	1	1	tier 1	010000		2	tier 1	011011011010000000000	30	30		30	30		30	30		30												tier 1	2	2		011011011010000000000	tier 1																						tier 1	10.00	30.00		10.00	30.00		10.00	30.00		10.00													3
S5775	002	0		29	10	S5775_002_0	10	4	1	Tier 4	100011		1	Tier 4	011011011010000000000	30	90		30	90		30	90		30												Tier 4	2	1	011011011010000000000		Tier 4	33	33		33	33		33	33		33												Tier 4																							3
S5775	003	0		29	10	S5775_003_0	10	1	1	Tier 1	010000	1	2	Tier 1	011011011010000000000	30	90		30	90		30	90		30												Tier 1	2	2		011011011010000000000	Tier 1																						Tier 1	4.00	12.00		4.00	12.00		4.00	12.00		4.00													4
S5775	003	0		29	10	S5775_003_0	10	2	1	tier 2	000001	1	2	tier 2	011011011010000000000	30	90		30	90		30	90		30												tier 2	2	2		011011011010000000000	tier 2																						tier 2	30.00	90.00		30.00	90.00		30.00	90.00		30.00													4
S5775	003	0		29	10	S5775_003_0	10	3	1	tier 3	100000	1	2	tier 3	011011011010000000000	30	90		30	90		30	90		30												tier 3	2	2		011011011010000000000	tier 3																						tier 3	60.00	180.00		60.00	180.00		60.00	180.00		60.00													4
S5775	003	0		29	10	S5775_003_0	10	4	1	Tier 4	100011	1	1	Tier 4	011011011010000000000	30	30		30	30		30	30		30												Tier 4	2	1	011011011010000000000		Tier 4	25	25		25	25		25	25		25												Tier 4																							4
S5775	003	0		29	10	S5775_003_0	10	1	3	Tier 1	010000	1	2	Tier 1	011011011010000000000	30	90		30	90		30	90		30												Tier 1	2	2		011011011010000000000	Tier 1																						Tier 1	4.00	12.00		4.00	12.00		4.00	12.00		4.00												1	4
S5775	003	0		29	10	S5775_003_0	10	2	3	tier 2	000001	1	2	tier 2																							tier 2					tier 2																						tier 2																						2	4
S5775	003	0		29	10	S5775_003_0	10	3	3	tier 3	100000	1	2	tier 3																							tier 3					tier 3																						tier 3																						2	4
S5775	003	0		29	10	S5775_003_0	10	4	3	Tier 4	100011	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5795	002	0		29	10	S5795_002_0	1	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5795	002	0		29	10	S5795_002_0	1	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	10.00								5.00				10.00								1	4
S5795	002	0		29	10	S5795_002_0	1	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5795	002	0		29	10	S5795_002_0	1	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5795	002	0		29	10	S5795_002_0	1	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
S5795	002	0		29	10	S5795_002_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5795	002	0		29	10	S5795_002_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	60.00								30.00				60.00									4
S5795	002	0		29	10	S5795_002_0	1	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	10.00								5.00				10.00									4
S5795	003	0		29	10	S5795_003_0	2	3	1	Specialty	010010		1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							3
S5795	003	0		29	10	S5795_003_0	2	2	1	Brand	000010		2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	36.00	72.00								36.00				72.00									3
S5795	003	0		29	10	S5795_003_0	2	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	10.00								5.00				10.00									3
S5795	006	0		29	10	S5795_006_0	1	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5795	006	0		29	10	S5795_006_0	1	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	25									25												Specialty																							4
S5795	006	0		29	10	S5795_006_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	60.00								30.00				60.00									4
S5795	006	0		29	10	S5795_006_0	1	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	10.00								5.00				10.00									4
S5803	070	0		29	10	S5803_070_0	6	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	070	0		29	10	S5803_070_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	070	0		29	10	S5803_070_0	6	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	071	0		29	10	S5803_071_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	071	0		29	10	S5803_071_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	071	0		29	10	S5803_071_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	072	0		29	10	S5803_072_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	072	0		29	10	S5803_072_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	072	0		29	10	S5803_072_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	073	0		29	10	S5803_073_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	073	0		29	10	S5803_073_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	073	0		29	10	S5803_073_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	074	0		29	10	S5803_074_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	074	0		29	10	S5803_074_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	074	0		29	10	S5803_074_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	075	0		29	10	S5803_075_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	075	0		29	10	S5803_075_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	075	0		29	10	S5803_075_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	076	0		29	10	S5803_076_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	076	0		29	10	S5803_076_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	076	0		29	10	S5803_076_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	077	0		29	10	S5803_077_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	077	0		29	10	S5803_077_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	077	0		29	10	S5803_077_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	078	0		29	10	S5803_078_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	078	0		29	10	S5803_078_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	078	0		29	10	S5803_078_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	079	0		29	10	S5803_079_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	079	0		29	10	S5803_079_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	079	0		29	10	S5803_079_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	080	0		29	10	S5803_080_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	080	0		29	10	S5803_080_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	080	0		29	10	S5803_080_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	081	0		29	10	S5803_081_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	081	0		29	10	S5803_081_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	081	0		29	10	S5803_081_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	082	0		29	10	S5803_082_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	082	0		29	10	S5803_082_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	082	0		29	10	S5803_082_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	083	0		29	10	S5803_083_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	083	0		29	10	S5803_083_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	083	0		29	10	S5803_083_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	084	0		29	10	S5803_084_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	084	0		29	10	S5803_084_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	084	0		29	10	S5803_084_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	085	0		29	10	S5803_085_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	085	0		29	10	S5803_085_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	085	0		29	10	S5803_085_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	086	0		29	10	S5803_086_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	086	0		29	10	S5803_086_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	086	0		29	10	S5803_086_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	087	0		29	10	S5803_087_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	087	0		29	10	S5803_087_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	087	0		29	10	S5803_087_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	088	0		29	10	S5803_088_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	088	0		29	10	S5803_088_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	088	0		29	10	S5803_088_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	089	0		29	10	S5803_089_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	089	0		29	10	S5803_089_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	089	0		29	10	S5803_089_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	090	0		29	10	S5803_090_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	090	0		29	10	S5803_090_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	090	0		29	10	S5803_090_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	091	0		29	10	S5803_091_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	091	0		29	10	S5803_091_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	091	0		29	10	S5803_091_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	092	0		29	10	S5803_092_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	092	0		29	10	S5803_092_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	092	0		29	10	S5803_092_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	093	0		29	10	S5803_093_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	093	0		29	10	S5803_093_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	093	0		29	10	S5803_093_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	094	0		29	10	S5803_094_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	094	0		29	10	S5803_094_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	094	0		29	10	S5803_094_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	095	0		29	10	S5803_095_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	095	0		29	10	S5803_095_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	095	0		29	10	S5803_095_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	096	0		29	10	S5803_096_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	096	0		29	10	S5803_096_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	096	0		29	10	S5803_096_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	097	0		29	10	S5803_097_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	097	0		29	10	S5803_097_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	097	0		29	10	S5803_097_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	098	0		29	10	S5803_098_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	098	0		29	10	S5803_098_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	098	0		29	10	S5803_098_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	099	0		29	10	S5803_099_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	099	0		29	10	S5803_099_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	099	0		29	10	S5803_099_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	100	0		29	10	S5803_100_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	100	0		29	10	S5803_100_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	100	0		29	10	S5803_100_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	101	0		29	10	S5803_101_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	101	0		29	10	S5803_101_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	101	0		29	10	S5803_101_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	102	0		29	10	S5803_102_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	102	0		29	10	S5803_102_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	102	0		29	10	S5803_102_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	103	0		29	10	S5803_103_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	103	0		29	10	S5803_103_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	103	0		29	10	S5803_103_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	138	0		29	10	S5803_138_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	138	0		29	10	S5803_138_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	138	0		29	10	S5803_138_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	138	0		29	10	S5803_138_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	139	0		29	10	S5803_139_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	139	0		29	10	S5803_139_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	139	0		29	10	S5803_139_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	139	0		29	10	S5803_139_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	140	0		29	10	S5803_140_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	140	0		29	10	S5803_140_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	140	0		29	10	S5803_140_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	140	0		29	10	S5803_140_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	141	0		29	10	S5803_141_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	141	0		29	10	S5803_141_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	141	0		29	10	S5803_141_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	141	0		29	10	S5803_141_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	142	0		29	10	S5803_142_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	142	0		29	10	S5803_142_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	142	0		29	10	S5803_142_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	142	0		29	10	S5803_142_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	143	0		29	10	S5803_143_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	143	0		29	10	S5803_143_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	143	0		29	10	S5803_143_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	143	0		29	10	S5803_143_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	144	0		29	10	S5803_144_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	144	0		29	10	S5803_144_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	144	0		29	10	S5803_144_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	144	0		29	10	S5803_144_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	145	0		29	10	S5803_145_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	145	0		29	10	S5803_145_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	145	0		29	10	S5803_145_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	145	0		29	10	S5803_145_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	146	0		29	10	S5803_146_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	146	0		29	10	S5803_146_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	146	0		29	10	S5803_146_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	146	0		29	10	S5803_146_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	147	0		29	10	S5803_147_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	147	0		29	10	S5803_147_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	147	0		29	10	S5803_147_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	147	0		29	10	S5803_147_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	148	0		29	10	S5803_148_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	148	0		29	10	S5803_148_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	148	0		29	10	S5803_148_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	148	0		29	10	S5803_148_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	149	0		29	10	S5803_149_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	149	0		29	10	S5803_149_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	149	0		29	10	S5803_149_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	149	0		29	10	S5803_149_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	150	0		29	10	S5803_150_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	150	0		29	10	S5803_150_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	150	0		29	10	S5803_150_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	150	0		29	10	S5803_150_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	151	0		29	10	S5803_151_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	151	0		29	10	S5803_151_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	151	0		29	10	S5803_151_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	151	0		29	10	S5803_151_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	152	0		29	10	S5803_152_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	152	0		29	10	S5803_152_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	152	0		29	10	S5803_152_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	152	0		29	10	S5803_152_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	153	0		29	10	S5803_153_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	153	0		29	10	S5803_153_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	153	0		29	10	S5803_153_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	153	0		29	10	S5803_153_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	154	0		29	10	S5803_154_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	154	0		29	10	S5803_154_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	154	0		29	10	S5803_154_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	154	0		29	10	S5803_154_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	155	0		29	10	S5803_155_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	155	0		29	10	S5803_155_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	155	0		29	10	S5803_155_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	155	0		29	10	S5803_155_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	156	0		29	10	S5803_156_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	156	0		29	10	S5803_156_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	156	0		29	10	S5803_156_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	156	0		29	10	S5803_156_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	157	0		29	10	S5803_157_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	157	0		29	10	S5803_157_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	157	0		29	10	S5803_157_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	157	0		29	10	S5803_157_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	158	0		29	10	S5803_158_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	158	0		29	10	S5803_158_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	158	0		29	10	S5803_158_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	158	0		29	10	S5803_158_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	159	0		29	10	S5803_159_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	159	0		29	10	S5803_159_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	159	0		29	10	S5803_159_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	159	0		29	10	S5803_159_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	160	0		29	10	S5803_160_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	160	0		29	10	S5803_160_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	160	0		29	10	S5803_160_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	160	0		29	10	S5803_160_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	161	0		29	10	S5803_161_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	161	0		29	10	S5803_161_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	161	0		29	10	S5803_161_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	161	0		29	10	S5803_161_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	162	0		29	10	S5803_162_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	162	0		29	10	S5803_162_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	162	0		29	10	S5803_162_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	162	0		29	10	S5803_162_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	163	0		29	10	S5803_163_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	163	0		29	10	S5803_163_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	163	0		29	10	S5803_163_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	163	0		29	10	S5803_163_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	164	0		29	10	S5803_164_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	164	0		29	10	S5803_164_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	164	0		29	10	S5803_164_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	164	0		29	10	S5803_164_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	165	0		29	10	S5803_165_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	165	0		29	10	S5803_165_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	165	0		29	10	S5803_165_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	165	0		29	10	S5803_165_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	166	0		29	10	S5803_166_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	166	0		29	10	S5803_166_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	166	0		29	10	S5803_166_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	166	0		29	10	S5803_166_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	167	0		29	10	S5803_167_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	167	0		29	10	S5803_167_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	167	0		29	10	S5803_167_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	167	0		29	10	S5803_167_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	168	0		29	10	S5803_168_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	168	0		29	10	S5803_168_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	168	0		29	10	S5803_168_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	168	0		29	10	S5803_168_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	169	0		29	10	S5803_169_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	169	0		29	10	S5803_169_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	169	0		29	10	S5803_169_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	169	0		29	10	S5803_169_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	170	0		29	10	S5803_170_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	170	0		29	10	S5803_170_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	170	0		29	10	S5803_170_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	170	0		29	10	S5803_170_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	171	0		29	10	S5803_171_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	171	0		29	10	S5803_171_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	171	0		29	10	S5803_171_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	171	0		29	10	S5803_171_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	210	0		29	10	S5803_210_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	210	0		29	10	S5803_210_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	210	0		29	10	S5803_210_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	211	0		29	10	S5803_211_0	5	3	1	Formulary Brand	100000		2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	1	011000000010000000000		Formulary Brand	50	40								50												Formulary Brand																							3
S5803	211	0		29	10	S5803_211_0	5	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	1	011000000010000000000		Preferred Brand	25	20								25												Preferred Brand																							3
S5803	211	0		29	10	S5803_211_0	5	1	1	Formulary Generic	010000		2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													3
S5803	214	0		29	10	S5803_214_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	214	0		29	10	S5803_214_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	214	0		29	10	S5803_214_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	214	0		29	10	S5803_214_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	215	0		29	10	S5803_215_0	4	4	1	Specialty	000010	1	1	Specialty	011000000010000000000	30	90								30												Specialty	2	1	011000000010000000000		Specialty	25	25								25												Specialty																							4
S5803	215	0		29	10	S5803_215_0	4	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	45.00	112.50								45.00													4
S5803	215	0		29	10	S5803_215_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	20.00	50.00								20.00													4
S5803	215	0		29	10	S5803_215_0	4	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	0.00	0.00								0.00													4
S5803	218	0		29	10	S5803_218_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	218	0		29	10	S5803_218_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	218	0		29	10	S5803_218_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	218	0		29	10	S5803_218_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	218	0		29	10	S5803_218_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	218	0		29	10	S5803_218_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	218	0		29	10	S5803_218_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	218	0		29	10	S5803_218_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	219	0		29	10	S5803_219_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	219	0		29	10	S5803_219_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	219	0		29	10	S5803_219_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	219	0		29	10	S5803_219_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	219	0		29	10	S5803_219_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	219	0		29	10	S5803_219_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	219	0		29	10	S5803_219_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	219	0		29	10	S5803_219_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	220	0		29	10	S5803_220_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	220	0		29	10	S5803_220_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	220	0		29	10	S5803_220_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	220	0		29	10	S5803_220_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	220	0		29	10	S5803_220_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	220	0		29	10	S5803_220_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	220	0		29	10	S5803_220_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	220	0		29	10	S5803_220_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	221	0		29	10	S5803_221_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	221	0		29	10	S5803_221_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	221	0		29	10	S5803_221_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	221	0		29	10	S5803_221_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	221	0		29	10	S5803_221_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	221	0		29	10	S5803_221_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	221	0		29	10	S5803_221_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	221	0		29	10	S5803_221_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	222	0		29	10	S5803_222_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	222	0		29	10	S5803_222_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	222	0		29	10	S5803_222_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	222	0		29	10	S5803_222_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	222	0		29	10	S5803_222_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	222	0		29	10	S5803_222_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	222	0		29	10	S5803_222_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	222	0		29	10	S5803_222_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	223	0		29	10	S5803_223_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	223	0		29	10	S5803_223_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	223	0		29	10	S5803_223_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	223	0		29	10	S5803_223_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	223	0		29	10	S5803_223_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	223	0		29	10	S5803_223_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	223	0		29	10	S5803_223_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	223	0		29	10	S5803_223_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	224	0		29	10	S5803_224_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	224	0		29	10	S5803_224_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	224	0		29	10	S5803_224_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	224	0		29	10	S5803_224_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	224	0		29	10	S5803_224_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	224	0		29	10	S5803_224_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	224	0		29	10	S5803_224_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	224	0		29	10	S5803_224_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	225	0		29	10	S5803_225_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	225	0		29	10	S5803_225_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	225	0		29	10	S5803_225_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	225	0		29	10	S5803_225_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	225	0		29	10	S5803_225_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	225	0		29	10	S5803_225_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	225	0		29	10	S5803_225_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	225	0		29	10	S5803_225_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	226	0		29	10	S5803_226_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	226	0		29	10	S5803_226_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	226	0		29	10	S5803_226_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	226	0		29	10	S5803_226_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	226	0		29	10	S5803_226_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	226	0		29	10	S5803_226_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	226	0		29	10	S5803_226_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	226	0		29	10	S5803_226_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	227	0		29	10	S5803_227_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	227	0		29	10	S5803_227_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	227	0		29	10	S5803_227_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	227	0		29	10	S5803_227_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	227	0		29	10	S5803_227_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	227	0		29	10	S5803_227_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	227	0		29	10	S5803_227_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	227	0		29	10	S5803_227_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	228	0		29	10	S5803_228_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	228	0		29	10	S5803_228_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	228	0		29	10	S5803_228_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	228	0		29	10	S5803_228_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	228	0		29	10	S5803_228_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	228	0		29	10	S5803_228_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	228	0		29	10	S5803_228_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	228	0		29	10	S5803_228_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	229	0		29	10	S5803_229_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	229	0		29	10	S5803_229_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	229	0		29	10	S5803_229_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	229	0		29	10	S5803_229_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	229	0		29	10	S5803_229_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	229	0		29	10	S5803_229_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	229	0		29	10	S5803_229_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	229	0		29	10	S5803_229_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	230	0		29	10	S5803_230_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	230	0		29	10	S5803_230_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	230	0		29	10	S5803_230_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	230	0		29	10	S5803_230_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	230	0		29	10	S5803_230_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	230	0		29	10	S5803_230_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	230	0		29	10	S5803_230_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	230	0		29	10	S5803_230_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	231	0		29	10	S5803_231_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	231	0		29	10	S5803_231_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	231	0		29	10	S5803_231_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	231	0		29	10	S5803_231_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	231	0		29	10	S5803_231_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	231	0		29	10	S5803_231_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	231	0		29	10	S5803_231_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	231	0		29	10	S5803_231_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	232	0		29	10	S5803_232_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	232	0		29	10	S5803_232_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	232	0		29	10	S5803_232_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	232	0		29	10	S5803_232_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	232	0		29	10	S5803_232_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	232	0		29	10	S5803_232_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	232	0		29	10	S5803_232_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	232	0		29	10	S5803_232_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	233	0		29	10	S5803_233_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	233	0		29	10	S5803_233_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	233	0		29	10	S5803_233_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	233	0		29	10	S5803_233_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	233	0		29	10	S5803_233_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	233	0		29	10	S5803_233_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	233	0		29	10	S5803_233_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	233	0		29	10	S5803_233_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	234	0		29	10	S5803_234_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	234	0		29	10	S5803_234_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	234	0		29	10	S5803_234_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	234	0		29	10	S5803_234_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	234	0		29	10	S5803_234_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	234	0		29	10	S5803_234_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	234	0		29	10	S5803_234_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	234	0		29	10	S5803_234_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	235	0		29	10	S5803_235_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	235	0		29	10	S5803_235_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	235	0		29	10	S5803_235_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	235	0		29	10	S5803_235_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	235	0		29	10	S5803_235_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	235	0		29	10	S5803_235_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	235	0		29	10	S5803_235_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	235	0		29	10	S5803_235_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	236	0		29	10	S5803_236_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	236	0		29	10	S5803_236_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	236	0		29	10	S5803_236_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	236	0		29	10	S5803_236_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	236	0		29	10	S5803_236_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	236	0		29	10	S5803_236_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	236	0		29	10	S5803_236_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	236	0		29	10	S5803_236_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	237	0		29	10	S5803_237_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	237	0		29	10	S5803_237_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	237	0		29	10	S5803_237_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	237	0		29	10	S5803_237_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	237	0		29	10	S5803_237_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	237	0		29	10	S5803_237_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	237	0		29	10	S5803_237_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	237	0		29	10	S5803_237_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	238	0		29	10	S5803_238_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	238	0		29	10	S5803_238_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	238	0		29	10	S5803_238_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	238	0		29	10	S5803_238_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	238	0		29	10	S5803_238_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	238	0		29	10	S5803_238_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	238	0		29	10	S5803_238_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	238	0		29	10	S5803_238_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	239	0		29	10	S5803_239_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	239	0		29	10	S5803_239_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	239	0		29	10	S5803_239_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	239	0		29	10	S5803_239_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	239	0		29	10	S5803_239_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	239	0		29	10	S5803_239_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	239	0		29	10	S5803_239_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	239	0		29	10	S5803_239_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	240	0		29	10	S5803_240_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	240	0		29	10	S5803_240_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	240	0		29	10	S5803_240_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	240	0		29	10	S5803_240_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	240	0		29	10	S5803_240_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	240	0		29	10	S5803_240_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	240	0		29	10	S5803_240_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	240	0		29	10	S5803_240_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	241	0		29	10	S5803_241_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	241	0		29	10	S5803_241_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	241	0		29	10	S5803_241_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	241	0		29	10	S5803_241_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	241	0		29	10	S5803_241_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	241	0		29	10	S5803_241_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	241	0		29	10	S5803_241_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	241	0		29	10	S5803_241_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	242	0		29	10	S5803_242_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	242	0		29	10	S5803_242_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	242	0		29	10	S5803_242_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	242	0		29	10	S5803_242_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	242	0		29	10	S5803_242_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	242	0		29	10	S5803_242_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	242	0		29	10	S5803_242_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	242	0		29	10	S5803_242_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	243	0		29	10	S5803_243_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	243	0		29	10	S5803_243_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	243	0		29	10	S5803_243_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	243	0		29	10	S5803_243_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	243	0		29	10	S5803_243_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	243	0		29	10	S5803_243_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	243	0		29	10	S5803_243_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	243	0		29	10	S5803_243_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	244	0		29	10	S5803_244_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	244	0		29	10	S5803_244_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	244	0		29	10	S5803_244_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	244	0		29	10	S5803_244_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	244	0		29	10	S5803_244_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	244	0		29	10	S5803_244_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	244	0		29	10	S5803_244_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	244	0		29	10	S5803_244_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	245	0		29	10	S5803_245_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	245	0		29	10	S5803_245_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	245	0		29	10	S5803_245_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	245	0		29	10	S5803_245_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	245	0		29	10	S5803_245_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	245	0		29	10	S5803_245_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	245	0		29	10	S5803_245_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	245	0		29	10	S5803_245_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	246	0		29	10	S5803_246_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	246	0		29	10	S5803_246_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	246	0		29	10	S5803_246_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	246	0		29	10	S5803_246_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	246	0		29	10	S5803_246_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	246	0		29	10	S5803_246_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	246	0		29	10	S5803_246_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	246	0		29	10	S5803_246_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	247	0		29	10	S5803_247_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	247	0		29	10	S5803_247_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	247	0		29	10	S5803_247_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	247	0		29	10	S5803_247_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	247	0		29	10	S5803_247_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	247	0		29	10	S5803_247_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	247	0		29	10	S5803_247_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	247	0		29	10	S5803_247_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	248	0		29	10	S5803_248_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	248	0		29	10	S5803_248_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	248	0		29	10	S5803_248_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	248	0		29	10	S5803_248_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	248	0		29	10	S5803_248_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	248	0		29	10	S5803_248_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	248	0		29	10	S5803_248_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	248	0		29	10	S5803_248_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	249	0		29	10	S5803_249_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	249	0		29	10	S5803_249_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	249	0		29	10	S5803_249_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	249	0		29	10	S5803_249_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	249	0		29	10	S5803_249_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	249	0		29	10	S5803_249_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	249	0		29	10	S5803_249_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	249	0		29	10	S5803_249_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	250	0		29	10	S5803_250_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	250	0		29	10	S5803_250_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	250	0		29	10	S5803_250_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	250	0		29	10	S5803_250_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	250	0		29	10	S5803_250_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	250	0		29	10	S5803_250_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	250	0		29	10	S5803_250_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	250	0		29	10	S5803_250_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	251	0		29	10	S5803_251_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	251	0		29	10	S5803_251_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	251	0		29	10	S5803_251_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	251	0		29	10	S5803_251_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	251	0		29	10	S5803_251_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	251	0		29	10	S5803_251_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	251	0		29	10	S5803_251_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	251	0		29	10	S5803_251_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	252	0		29	10	S5803_252_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	252	0		29	10	S5803_252_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	252	0		29	10	S5803_252_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	252	0		29	10	S5803_252_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	252	0		29	10	S5803_252_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5803	252	0		29	10	S5803_252_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	252	0		29	10	S5803_252_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	252	0		29	10	S5803_252_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	253	0		29	10	S5803_253_0	3	1	1	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00													4
S5803	253	0		29	10	S5803_253_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000000000	30	90								30												Preferred Brand	2	2		011000000010000000000	Preferred Brand																						Preferred Brand	25.00	62.50								25.00													4
S5803	253	0		29	10	S5803_253_0	3	3	1	Formulary Brand	100000	1	2	Formulary Brand	011000000010000000000	30	90								30												Formulary Brand	2	2		011000000010000000000	Formulary Brand																						Formulary Brand	50.00	125.00								50.00													4
S5803	253	0		29	10	S5803_253_0	3	3	3	Formulary Brand	100000	1	2	Formulary Brand																							Formulary Brand					Formulary Brand																						Formulary Brand																						2	4
S5803	253	0		29	10	S5803_253_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5803	253	0		29	10	S5803_253_0	3	1	3	Formulary Generic	010000	1	2	Formulary Generic	011000000010000000000	30	90								30												Formulary Generic	2	2		011000000010000000000	Formulary Generic																						Formulary Generic	5.00	12.50								5.00												1	4
S5803	253	0		29	10	S5803_253_0	3	4	1	Specialty Tier	000010	1	1	Specialty Tier	011000000010000000000	30	90								30												Specialty Tier	2	1	011000000010000000000		Specialty Tier	25	25								25												Specialty Tier																							4
S5803	253	0		29	10	S5803_253_0	3	4	3	Specialty Tier	000010	1	1	Specialty Tier																							Specialty Tier					Specialty Tier																						Specialty Tier																						2	4
S5805	001	0		29	10	S5805_001_0	2	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5805	001	0		29	10	S5805_001_0	2	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5805	001	0		29	10	S5805_001_0	2	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5805	001	0		29	10	S5805_001_0	2	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	64.85	194.55								64.85							179.55			194.55			3
S5805	004	0		29	10	S5805_004_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5805	004	0		29	10	S5805_004_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5805	004	0		29	10	S5805_004_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5805	004	0		29	10	S5805_004_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5810	035	0		29	10	S5810_035_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	035	0		29	10	S5810_035_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	035	0		29	10	S5810_035_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	036	0		29	10	S5810_036_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	036	0		29	10	S5810_036_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	036	0		29	10	S5810_036_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	037	0		29	10	S5810_037_0	2	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				5.00	12.50		5.00	15.00		10.00							10.00			15.00			3
S5810	037	0		29	10	S5810_037_0	2	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				35.00	87.50		35.00	105.00		70.00							70.00			105.00			3
S5810	037	0		29	10	S5810_037_0	2	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				25	25		25	25		25							25			25		Tier Three																							3
S5810	038	0		29	10	S5810_038_0	2	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				5.00	12.50		5.00	15.00		10.00							10.00			15.00			3
S5810	038	0		29	10	S5810_038_0	2	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				35.00	87.50		35.00	105.00		70.00							70.00			105.00			3
S5810	038	0		29	10	S5810_038_0	2	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				25	25		25	25		25							25			25		Tier Three																							3
S5810	039	0		29	10	S5810_039_0	2	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				5.00	12.50		5.00	15.00		10.00							10.00			15.00			3
S5810	039	0		29	10	S5810_039_0	2	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				35.00	87.50		35.00	105.00		70.00							70.00			105.00			3
S5810	039	0		29	10	S5810_039_0	2	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				25	25		25	25		25							25			25		Tier Three																							3
S5810	040	0		29	10	S5810_040_0	2	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				5.00	12.50		5.00	15.00		10.00							10.00			15.00			3
S5810	040	0		29	10	S5810_040_0	2	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				35.00	87.50		35.00	105.00		70.00							70.00			105.00			3
S5810	040	0		29	10	S5810_040_0	2	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				25	25		25	25		25							25			25		Tier Three																							3
S5810	041	0		29	10	S5810_041_0	2	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				5.00	12.50		5.00	15.00		10.00							10.00			15.00			3
S5810	041	0		29	10	S5810_041_0	2	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				35.00	87.50		35.00	105.00		70.00							70.00			105.00			3
S5810	041	0		29	10	S5810_041_0	2	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				25	25		25	25		25							25			25		Tier Three																							3
S5810	042	0		29	10	S5810_042_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	042	0		29	10	S5810_042_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	042	0		29	10	S5810_042_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	043	0		29	10	S5810_043_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	043	0		29	10	S5810_043_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	043	0		29	10	S5810_043_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	044	0		29	10	S5810_044_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	044	0		29	10	S5810_044_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	044	0		29	10	S5810_044_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	045	0		29	10	S5810_045_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	045	0		29	10	S5810_045_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	045	0		29	10	S5810_045_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	046	0		29	10	S5810_046_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	046	0		29	10	S5810_046_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	046	0		29	10	S5810_046_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	047	0		29	10	S5810_047_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	047	0		29	10	S5810_047_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	047	0		29	10	S5810_047_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	048	0		29	10	S5810_048_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	048	0		29	10	S5810_048_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	048	0		29	10	S5810_048_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	049	0		29	10	S5810_049_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	049	0		29	10	S5810_049_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	049	0		29	10	S5810_049_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	050	0		29	10	S5810_050_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	050	0		29	10	S5810_050_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	050	0		29	10	S5810_050_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	051	0		29	10	S5810_051_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	051	0		29	10	S5810_051_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	051	0		29	10	S5810_051_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	052	0		29	10	S5810_052_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	052	0		29	10	S5810_052_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	052	0		29	10	S5810_052_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	053	0		29	10	S5810_053_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	053	0		29	10	S5810_053_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	053	0		29	10	S5810_053_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	054	0		29	10	S5810_054_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	054	0		29	10	S5810_054_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	054	0		29	10	S5810_054_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	055	0		29	10	S5810_055_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	055	0		29	10	S5810_055_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	055	0		29	10	S5810_055_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	056	0		29	10	S5810_056_0	2	1	1	Tier One	010000		2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				5.00	12.50		5.00	15.00		10.00							10.00			15.00			3
S5810	056	0		29	10	S5810_056_0	2	2	1	Tier Two	000010		2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				35.00	87.50		35.00	105.00		70.00							70.00			105.00			3
S5810	056	0		29	10	S5810_056_0	2	3	1	Tier Three	010010		1	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	1	000011011010000001001		Tier Three				25	25		25	25		25							25			25		Tier Three																							3
S5810	057	0		29	10	S5810_057_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	057	0		29	10	S5810_057_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	057	0		29	10	S5810_057_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	058	0		29	10	S5810_058_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	058	0		29	10	S5810_058_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	058	0		29	10	S5810_058_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	059	0		29	10	S5810_059_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	059	0		29	10	S5810_059_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	059	0		29	10	S5810_059_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	060	0		29	10	S5810_060_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	060	0		29	10	S5810_060_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	060	0		29	10	S5810_060_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	061	0		29	10	S5810_061_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	061	0		29	10	S5810_061_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	061	0		29	10	S5810_061_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	062	0		29	10	S5810_062_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	062	0		29	10	S5810_062_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	062	0		29	10	S5810_062_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	063	0		29	10	S5810_063_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	063	0		29	10	S5810_063_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	063	0		29	10	S5810_063_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	064	0		29	10	S5810_064_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	064	0		29	10	S5810_064_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	064	0		29	10	S5810_064_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	065	0		29	10	S5810_065_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	065	0		29	10	S5810_065_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	065	0		29	10	S5810_065_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	066	0		29	10	S5810_066_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	066	0		29	10	S5810_066_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	066	0		29	10	S5810_066_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	067	0		29	10	S5810_067_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	067	0		29	10	S5810_067_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	067	0		29	10	S5810_067_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	068	0		29	10	S5810_068_0	2	1	1	Tier One	010000		2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	5.00	15.00								10.00							10.00			15.00			3
S5810	068	0		29	10	S5810_068_0	2	2	1	Tier Two	000010		2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	35.00	105.00								70.00							70.00			105.00			3
S5810	068	0		29	10	S5810_068_0	2	3	1	Tier Three	010010		1	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	1	011000000010000001001		Tier Three	25	25								25							25			25		Tier Three																							3
S5810	137	0		29	10	S5810_137_0	5	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	137	0		29	10	S5810_137_0	5	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	137	0		29	10	S5810_137_0	5	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	137	0		29	10	S5810_137_0	5	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	138	0		29	10	S5810_138_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	138	0		29	10	S5810_138_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	138	0		29	10	S5810_138_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	138	0		29	10	S5810_138_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	139	0		29	10	S5810_139_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	139	0		29	10	S5810_139_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
S5810	139	0		29	10	S5810_139_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
S5810	139	0		29	10	S5810_139_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	140	0		29	10	S5810_140_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	140	0		29	10	S5810_140_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
S5810	140	0		29	10	S5810_140_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
S5810	140	0		29	10	S5810_140_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	141	0		29	10	S5810_141_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	141	0		29	10	S5810_141_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
S5810	141	0		29	10	S5810_141_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
S5810	141	0		29	10	S5810_141_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	142	0		29	10	S5810_142_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
S5810	142	0		29	10	S5810_142_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
S5810	142	0		29	10	S5810_142_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	142	0		29	10	S5810_142_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	143	0		29	10	S5810_143_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	143	0		29	10	S5810_143_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
S5810	143	0		29	10	S5810_143_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	143	0		29	10	S5810_143_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
S5810	144	0		29	10	S5810_144_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	144	0		29	10	S5810_144_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	144	0		29	10	S5810_144_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	144	0		29	10	S5810_144_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	145	0		29	10	S5810_145_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	145	0		29	10	S5810_145_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	145	0		29	10	S5810_145_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	145	0		29	10	S5810_145_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	146	0		29	10	S5810_146_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	146	0		29	10	S5810_146_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	146	0		29	10	S5810_146_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	146	0		29	10	S5810_146_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	147	0		29	10	S5810_147_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	147	0		29	10	S5810_147_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	147	0		29	10	S5810_147_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	147	0		29	10	S5810_147_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	148	0		29	10	S5810_148_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	148	0		29	10	S5810_148_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	148	0		29	10	S5810_148_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	148	0		29	10	S5810_148_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	149	0		29	10	S5810_149_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	149	0		29	10	S5810_149_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	149	0		29	10	S5810_149_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	149	0		29	10	S5810_149_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	150	0		29	10	S5810_150_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	150	0		29	10	S5810_150_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	150	0		29	10	S5810_150_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	150	0		29	10	S5810_150_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	151	0		29	10	S5810_151_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	151	0		29	10	S5810_151_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	151	0		29	10	S5810_151_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	151	0		29	10	S5810_151_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	152	0		29	10	S5810_152_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	152	0		29	10	S5810_152_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	152	0		29	10	S5810_152_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	152	0		29	10	S5810_152_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	153	0		29	10	S5810_153_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	153	0		29	10	S5810_153_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	153	0		29	10	S5810_153_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	153	0		29	10	S5810_153_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	154	0		29	10	S5810_154_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	154	0		29	10	S5810_154_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	154	0		29	10	S5810_154_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	154	0		29	10	S5810_154_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	155	0		29	10	S5810_155_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	155	0		29	10	S5810_155_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	155	0		29	10	S5810_155_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	155	0		29	10	S5810_155_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	156	0		29	10	S5810_156_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	156	0		29	10	S5810_156_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	156	0		29	10	S5810_156_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	156	0		29	10	S5810_156_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	157	0		29	10	S5810_157_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	157	0		29	10	S5810_157_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	157	0		29	10	S5810_157_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	157	0		29	10	S5810_157_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	158	0		29	10	S5810_158_0	4	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				30.00	75.00		30.00	90.00		60.00							60.00			90.00			4
S5810	158	0		29	10	S5810_158_0	4	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				60.00	150.00		60.00	180.00		110.00							120.00			180.00			4
S5810	158	0		29	10	S5810_158_0	4	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	158	0		29	10	S5810_158_0	4	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	159	0		29	10	S5810_159_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	159	0		29	10	S5810_159_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	159	0		29	10	S5810_159_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	159	0		29	10	S5810_159_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	160	0		29	10	S5810_160_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	160	0		29	10	S5810_160_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	160	0		29	10	S5810_160_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	160	0		29	10	S5810_160_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	161	0		29	10	S5810_161_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	161	0		29	10	S5810_161_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	161	0		29	10	S5810_161_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	161	0		29	10	S5810_161_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	162	0		29	10	S5810_162_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	162	0		29	10	S5810_162_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	162	0		29	10	S5810_162_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	162	0		29	10	S5810_162_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	163	0		29	10	S5810_163_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	163	0		29	10	S5810_163_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	163	0		29	10	S5810_163_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	163	0		29	10	S5810_163_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	164	0		29	10	S5810_164_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	164	0		29	10	S5810_164_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	164	0		29	10	S5810_164_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	164	0		29	10	S5810_164_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	165	0		29	10	S5810_165_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	165	0		29	10	S5810_165_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	165	0		29	10	S5810_165_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	165	0		29	10	S5810_165_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	166	0		29	10	S5810_166_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	166	0		29	10	S5810_166_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	166	0		29	10	S5810_166_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	166	0		29	10	S5810_166_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	167	0		29	10	S5810_167_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	167	0		29	10	S5810_167_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	167	0		29	10	S5810_167_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	167	0		29	10	S5810_167_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	168	0		29	10	S5810_168_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	168	0		29	10	S5810_168_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	168	0		29	10	S5810_168_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	168	0		29	10	S5810_168_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	169	0		29	10	S5810_169_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	169	0		29	10	S5810_169_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	169	0		29	10	S5810_169_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	169	0		29	10	S5810_169_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	170	0		29	10	S5810_170_0	4	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	60.00	180.00								110.00							120.00			180.00			4
S5810	170	0		29	10	S5810_170_0	4	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	30.00	90.00								60.00							60.00			90.00			4
S5810	170	0		29	10	S5810_170_0	4	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	170	0		29	10	S5810_170_0	4	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	171	0		29	10	S5810_171_0	3	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	171	0		29	10	S5810_171_0	3	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	171	0		29	10	S5810_171_0	3	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	171	0		29	10	S5810_171_0	3	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	171	0		29	10	S5810_171_0	3	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	171	0		29	10	S5810_171_0	3	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	171	0		29	10	S5810_171_0	3	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	171	0		29	10	S5810_171_0	3	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	172	0		29	10	S5810_172_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	172	0		29	10	S5810_172_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	172	0		29	10	S5810_172_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	172	0		29	10	S5810_172_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	172	0		29	10	S5810_172_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	172	0		29	10	S5810_172_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	172	0		29	10	S5810_172_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	172	0		29	10	S5810_172_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	173	0		29	10	S5810_173_0	2	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	173	0		29	10	S5810_173_0	2	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
S5810	173	0		29	10	S5810_173_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	173	0		29	10	S5810_173_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	173	0		29	10	S5810_173_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	173	0		29	10	S5810_173_0	2	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
S5810	173	0		29	10	S5810_173_0	2	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	173	0		29	10	S5810_173_0	2	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
S5810	174	0		29	10	S5810_174_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	174	0		29	10	S5810_174_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	174	0		29	10	S5810_174_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	174	0		29	10	S5810_174_0	2	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
S5810	174	0		29	10	S5810_174_0	2	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	174	0		29	10	S5810_174_0	2	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
S5810	174	0		29	10	S5810_174_0	2	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	174	0		29	10	S5810_174_0	2	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
S5810	175	0		29	10	S5810_175_0	2	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
S5810	175	0		29	10	S5810_175_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	175	0		29	10	S5810_175_0	2	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	175	0		29	10	S5810_175_0	2	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
S5810	175	0		29	10	S5810_175_0	2	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
S5810	175	0		29	10	S5810_175_0	2	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	175	0		29	10	S5810_175_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	175	0		29	10	S5810_175_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	176	0		29	10	S5810_176_0	2	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
S5810	176	0		29	10	S5810_176_0	2	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
S5810	176	0		29	10	S5810_176_0	2	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	176	0		29	10	S5810_176_0	2	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
S5810	176	0		29	10	S5810_176_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	176	0		29	10	S5810_176_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	176	0		29	10	S5810_176_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	176	0		29	10	S5810_176_0	2	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	177	0		29	10	S5810_177_0	2	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
S5810	177	0		29	10	S5810_177_0	2	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	177	0		29	10	S5810_177_0	2	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
S5810	177	0		29	10	S5810_177_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	177	0		29	10	S5810_177_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	177	0		29	10	S5810_177_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	177	0		29	10	S5810_177_0	2	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	177	0		29	10	S5810_177_0	2	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
S5810	178	0		29	10	S5810_178_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	178	0		29	10	S5810_178_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	178	0		29	10	S5810_178_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	178	0		29	10	S5810_178_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	178	0		29	10	S5810_178_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	178	0		29	10	S5810_178_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	178	0		29	10	S5810_178_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	178	0		29	10	S5810_178_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	179	0		29	10	S5810_179_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	179	0		29	10	S5810_179_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	179	0		29	10	S5810_179_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	179	0		29	10	S5810_179_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	179	0		29	10	S5810_179_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	179	0		29	10	S5810_179_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	179	0		29	10	S5810_179_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	179	0		29	10	S5810_179_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	180	0		29	10	S5810_180_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	180	0		29	10	S5810_180_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	180	0		29	10	S5810_180_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	180	0		29	10	S5810_180_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	180	0		29	10	S5810_180_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	180	0		29	10	S5810_180_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	180	0		29	10	S5810_180_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	180	0		29	10	S5810_180_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	181	0		29	10	S5810_181_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	181	0		29	10	S5810_181_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	181	0		29	10	S5810_181_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	181	0		29	10	S5810_181_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	181	0		29	10	S5810_181_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	181	0		29	10	S5810_181_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	181	0		29	10	S5810_181_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	181	0		29	10	S5810_181_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	182	0		29	10	S5810_182_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	182	0		29	10	S5810_182_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	182	0		29	10	S5810_182_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	182	0		29	10	S5810_182_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	182	0		29	10	S5810_182_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	182	0		29	10	S5810_182_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	182	0		29	10	S5810_182_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	182	0		29	10	S5810_182_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	183	0		29	10	S5810_183_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	183	0		29	10	S5810_183_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	183	0		29	10	S5810_183_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	183	0		29	10	S5810_183_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	183	0		29	10	S5810_183_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	183	0		29	10	S5810_183_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	183	0		29	10	S5810_183_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	183	0		29	10	S5810_183_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	184	0		29	10	S5810_184_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	184	0		29	10	S5810_184_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	184	0		29	10	S5810_184_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	184	0		29	10	S5810_184_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	184	0		29	10	S5810_184_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	184	0		29	10	S5810_184_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	184	0		29	10	S5810_184_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	184	0		29	10	S5810_184_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	185	0		29	10	S5810_185_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	185	0		29	10	S5810_185_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	185	0		29	10	S5810_185_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	185	0		29	10	S5810_185_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	185	0		29	10	S5810_185_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	185	0		29	10	S5810_185_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	185	0		29	10	S5810_185_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	185	0		29	10	S5810_185_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	186	0		29	10	S5810_186_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	186	0		29	10	S5810_186_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	186	0		29	10	S5810_186_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	186	0		29	10	S5810_186_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	186	0		29	10	S5810_186_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	186	0		29	10	S5810_186_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	186	0		29	10	S5810_186_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	186	0		29	10	S5810_186_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	187	0		29	10	S5810_187_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	187	0		29	10	S5810_187_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	187	0		29	10	S5810_187_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	187	0		29	10	S5810_187_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	187	0		29	10	S5810_187_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	187	0		29	10	S5810_187_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	187	0		29	10	S5810_187_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	187	0		29	10	S5810_187_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	188	0		29	10	S5810_188_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	188	0		29	10	S5810_188_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	188	0		29	10	S5810_188_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	188	0		29	10	S5810_188_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	188	0		29	10	S5810_188_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	188	0		29	10	S5810_188_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	188	0		29	10	S5810_188_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	188	0		29	10	S5810_188_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	189	0		29	10	S5810_189_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	189	0		29	10	S5810_189_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	189	0		29	10	S5810_189_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	189	0		29	10	S5810_189_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	189	0		29	10	S5810_189_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	189	0		29	10	S5810_189_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	189	0		29	10	S5810_189_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	189	0		29	10	S5810_189_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	190	0		29	10	S5810_190_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	190	0		29	10	S5810_190_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	190	0		29	10	S5810_190_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	190	0		29	10	S5810_190_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	190	0		29	10	S5810_190_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	190	0		29	10	S5810_190_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	190	0		29	10	S5810_190_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	190	0		29	10	S5810_190_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	191	0		29	10	S5810_191_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	191	0		29	10	S5810_191_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	191	0		29	10	S5810_191_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	191	0		29	10	S5810_191_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	191	0		29	10	S5810_191_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	191	0		29	10	S5810_191_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	191	0		29	10	S5810_191_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	191	0		29	10	S5810_191_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	192	0		29	10	S5810_192_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	192	0		29	10	S5810_192_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	192	0		29	10	S5810_192_0	2	1	1	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00			4
S5810	192	0		29	10	S5810_192_0	2	2	1	Tier Two	000001	1	2	Tier Two	000011011010000001001				31	90		31	90		31							90			90		Tier Two	2	2		000011011010000001001	Tier Two																						Tier Two				20.00	50.00		20.00	60.00		40.00							40.00			60.00			4
S5810	192	0		29	10	S5810_192_0	2	3	1	Tier Three	100000	1	2	Tier Three	000011011010000001001				31	90		31	90		31							90			90		Tier Three	2	2		000011011010000001001	Tier Three																						Tier Three				40.00	100.00		40.00	120.00		80.00							80.00			120.00			4
S5810	192	0		29	10	S5810_192_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	192	0		29	10	S5810_192_0	2	1	3	Tier One	010000	1	2	Tier One	000011011010000001001				31	90		31	90		31							90			90		Tier One	2	2		000011011010000001001	Tier One																						Tier One				0.00	0.00		0.00	0.00		0.00							0.00			0.00		1	4
S5810	192	0		29	10	S5810_192_0	2	4	1	Tier Four	010010	1	1	Tier Four	000011011010000001001				31	90		31	90		31							90			90		Tier Four	2	1	000011011010000001001		Tier Four				33	33		33	33		33							33			33		Tier Four																							4
S5810	193	0		29	10	S5810_193_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	193	0		29	10	S5810_193_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	193	0		29	10	S5810_193_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	193	0		29	10	S5810_193_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	193	0		29	10	S5810_193_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	193	0		29	10	S5810_193_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	193	0		29	10	S5810_193_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	193	0		29	10	S5810_193_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	194	0		29	10	S5810_194_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	194	0		29	10	S5810_194_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	194	0		29	10	S5810_194_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	194	0		29	10	S5810_194_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	194	0		29	10	S5810_194_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	194	0		29	10	S5810_194_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	194	0		29	10	S5810_194_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	194	0		29	10	S5810_194_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	195	0		29	10	S5810_195_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	195	0		29	10	S5810_195_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	195	0		29	10	S5810_195_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	195	0		29	10	S5810_195_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	195	0		29	10	S5810_195_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	195	0		29	10	S5810_195_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	195	0		29	10	S5810_195_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	195	0		29	10	S5810_195_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	196	0		29	10	S5810_196_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	196	0		29	10	S5810_196_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	196	0		29	10	S5810_196_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	196	0		29	10	S5810_196_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	196	0		29	10	S5810_196_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	196	0		29	10	S5810_196_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	196	0		29	10	S5810_196_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	196	0		29	10	S5810_196_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	197	0		29	10	S5810_197_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	197	0		29	10	S5810_197_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	197	0		29	10	S5810_197_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	197	0		29	10	S5810_197_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	197	0		29	10	S5810_197_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	197	0		29	10	S5810_197_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	197	0		29	10	S5810_197_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	197	0		29	10	S5810_197_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	198	0		29	10	S5810_198_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	198	0		29	10	S5810_198_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	198	0		29	10	S5810_198_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	198	0		29	10	S5810_198_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	198	0		29	10	S5810_198_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	198	0		29	10	S5810_198_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	198	0		29	10	S5810_198_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	198	0		29	10	S5810_198_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	199	0		29	10	S5810_199_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	199	0		29	10	S5810_199_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	199	0		29	10	S5810_199_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	199	0		29	10	S5810_199_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	199	0		29	10	S5810_199_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	199	0		29	10	S5810_199_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	199	0		29	10	S5810_199_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	199	0		29	10	S5810_199_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	200	0		29	10	S5810_200_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	200	0		29	10	S5810_200_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	200	0		29	10	S5810_200_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	200	0		29	10	S5810_200_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	200	0		29	10	S5810_200_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	200	0		29	10	S5810_200_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	200	0		29	10	S5810_200_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	200	0		29	10	S5810_200_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	201	0		29	10	S5810_201_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	201	0		29	10	S5810_201_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	201	0		29	10	S5810_201_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	201	0		29	10	S5810_201_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	201	0		29	10	S5810_201_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	201	0		29	10	S5810_201_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	201	0		29	10	S5810_201_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	201	0		29	10	S5810_201_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	202	0		29	10	S5810_202_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	202	0		29	10	S5810_202_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	202	0		29	10	S5810_202_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	202	0		29	10	S5810_202_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	202	0		29	10	S5810_202_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	202	0		29	10	S5810_202_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	202	0		29	10	S5810_202_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	202	0		29	10	S5810_202_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	203	0		29	10	S5810_203_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	203	0		29	10	S5810_203_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	203	0		29	10	S5810_203_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	203	0		29	10	S5810_203_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	203	0		29	10	S5810_203_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5810	203	0		29	10	S5810_203_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	203	0		29	10	S5810_203_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	203	0		29	10	S5810_203_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	204	0		29	10	S5810_204_0	2	1	1	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00			4
S5810	204	0		29	10	S5810_204_0	2	2	1	Tier Two	000001	1	2	Tier Two	011000000010000001001	31	90								31							90			90		Tier Two	2	2		011000000010000001001	Tier Two																						Tier Two	20.00	60.00								40.00							40.00			60.00			4
S5810	204	0		29	10	S5810_204_0	2	3	1	Tier Three	100000	1	2	Tier Three	011000000010000001001	31	90								31							90			90		Tier Three	2	2		011000000010000001001	Tier Three																						Tier Three	40.00	120.00								80.00							80.00			120.00			4
S5810	204	0		29	10	S5810_204_0	2	4	1	Tier Four	010010	1	1	Tier Four	011000000010000001001	31	90								31							90			90		Tier Four	2	1	011000000010000001001		Tier Four	33	33								33							33			33		Tier Four																							4
S5810	204	0		29	10	S5810_204_0	2	1	3	Tier One	010000	1	2	Tier One	011000000010000001001	31	90								31							90			90		Tier One	2	2		011000000010000001001	Tier One																						Tier One	0.00	0.00								0.00							0.00			0.00		1	4
S5810	204	0		29	10	S5810_204_0	2	4	3	Tier Four	010010	1	1	Tier Four																							Tier Four					Tier Four																						Tier Four																						2	4
S5810	204	0		29	10	S5810_204_0	2	2	3	Tier Two	000001	1	2	Tier Two																							Tier Two					Tier Two																						Tier Two																						2	4
S5810	204	0		29	10	S5810_204_0	2	3	3	Tier Three	100000	1	2	Tier Three																							Tier Three					Tier Three																						Tier Three																						2	4
S5820	001	0		29	10	S5820_001_0	2	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.35	205.05								68.35							190.05			205.05			3
S5820	001	0		29	10	S5820_001_0	2	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	001	0		29	10	S5820_001_0	2	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	001	0		29	10	S5820_001_0	2	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	002	0		29	10	S5820_002_0	2	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.50	205.50								68.50							190.50			205.50			3
S5820	002	0		29	10	S5820_002_0	2	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	002	0		29	10	S5820_002_0	2	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	002	0		29	10	S5820_002_0	2	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	003	0		29	10	S5820_003_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	003	0		29	10	S5820_003_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	003	0		29	10	S5820_003_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.25	201.75								67.25							186.75			201.75			3
S5820	003	0		29	10	S5820_003_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	004	0		29	10	S5820_004_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	004	0		29	10	S5820_004_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	004	0		29	10	S5820_004_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	69.10	207.30								69.10							192.30			207.30			3
S5820	004	0		29	10	S5820_004_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	005	0		29	10	S5820_005_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	005	0		29	10	S5820_005_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	005	0		29	10	S5820_005_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	005	0		29	10	S5820_005_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	64.95	194.85								64.95							179.85			194.85			3
S5820	006	0		29	10	S5820_006_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.85	203.55								67.85							188.55			203.55			3
S5820	006	0		29	10	S5820_006_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	006	0		29	10	S5820_006_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	006	0		29	10	S5820_006_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	007	0		29	10	S5820_007_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.05	186.15								62.05							171.15			186.15			3
S5820	007	0		29	10	S5820_007_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	007	0		29	10	S5820_007_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	007	0		29	10	S5820_007_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	008	0		29	10	S5820_008_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	008	0		29	10	S5820_008_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	008	0		29	10	S5820_008_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	66.05	198.15								66.05							183.15			198.15			3
S5820	008	0		29	10	S5820_008_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	009	0		29	10	S5820_009_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	009	0		29	10	S5820_009_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	63.40	190.20								63.40							175.20			190.20			3
S5820	009	0		29	10	S5820_009_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	009	0		29	10	S5820_009_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	010	0		29	10	S5820_010_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	010	0		29	10	S5820_010_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	010	0		29	10	S5820_010_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	010	0		29	10	S5820_010_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.85	197.55								65.85							182.55			197.55			3
S5820	011	0		29	10	S5820_011_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	011	0		29	10	S5820_011_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	61.85	185.55								61.85							170.55			185.55			3
S5820	011	0		29	10	S5820_011_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	011	0		29	10	S5820_011_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	012	0		29	10	S5820_012_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	012	0		29	10	S5820_012_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.70	188.10								62.70							173.10			188.10			3
S5820	012	0		29	10	S5820_012_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	012	0		29	10	S5820_012_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	013	0		29	10	S5820_013_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	013	0		29	10	S5820_013_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	013	0		29	10	S5820_013_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.20	186.60								62.20							171.60			186.60			3
S5820	013	0		29	10	S5820_013_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	014	0		29	10	S5820_014_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	014	0		29	10	S5820_014_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							165.00			180.00			3
S5820	014	0		29	10	S5820_014_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	014	0		29	10	S5820_014_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	015	0		29	10	S5820_015_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	015	0		29	10	S5820_015_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	66.85	200.55								66.85							185.55			200.55			3
S5820	015	0		29	10	S5820_015_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	015	0		29	10	S5820_015_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	016	0		29	10	S5820_016_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	016	0		29	10	S5820_016_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	016	0		29	10	S5820_016_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	69.25	207.75								69.25							192.75			207.75			3
S5820	016	0		29	10	S5820_016_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	017	0		29	10	S5820_017_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	017	0		29	10	S5820_017_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	017	0		29	10	S5820_017_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	017	0		29	10	S5820_017_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	61.30	183.90								61.30							168.90			183.90			3
S5820	018	0		29	10	S5820_018_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	018	0		29	10	S5820_018_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	63.10	189.30								63.10							174.30			189.30			3
S5820	018	0		29	10	S5820_018_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	018	0		29	10	S5820_018_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	019	0		29	10	S5820_019_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	019	0		29	10	S5820_019_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	019	0		29	10	S5820_019_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.45	187.35								62.45							172.35			187.35			3
S5820	019	0		29	10	S5820_019_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	020	0		29	10	S5820_020_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	020	0		29	10	S5820_020_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	020	0		29	10	S5820_020_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	64.00	192.00								64.00							177.00			192.00			3
S5820	020	0		29	10	S5820_020_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	021	0		29	10	S5820_021_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	021	0		29	10	S5820_021_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.35	196.05								65.35							181.05			196.05			3
S5820	021	0		29	10	S5820_021_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	021	0		29	10	S5820_021_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	022	0		29	10	S5820_022_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	022	0		29	10	S5820_022_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	022	0		29	10	S5820_022_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	022	0		29	10	S5820_022_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.95	188.85								62.95							173.85			188.85			3
S5820	023	0		29	10	S5820_023_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	023	0		29	10	S5820_023_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.95	188.85								62.95							173.85			188.85			3
S5820	023	0		29	10	S5820_023_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	023	0		29	10	S5820_023_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	024	0		29	10	S5820_024_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	024	0		29	10	S5820_024_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	024	0		29	10	S5820_024_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	024	0		29	10	S5820_024_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.05	195.15								65.05							180.15			195.15			3
S5820	025	0		29	10	S5820_025_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	025	0		29	10	S5820_025_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	025	0		29	10	S5820_025_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	71.35	214.05								71.35							199.05			214.05			3
S5820	025	0		29	10	S5820_025_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	026	0		29	10	S5820_026_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	026	0		29	10	S5820_026_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	026	0		29	10	S5820_026_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	026	0		29	10	S5820_026_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.20	204.60								68.20							189.60			204.60			3
S5820	027	0		29	10	S5820_027_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	66.55	199.65								66.55							184.65			199.65			3
S5820	027	0		29	10	S5820_027_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	027	0		29	10	S5820_027_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	027	0		29	10	S5820_027_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	028	0		29	10	S5820_028_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	70.60	211.80								70.60							196.80			211.80			3
S5820	028	0		29	10	S5820_028_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	028	0		29	10	S5820_028_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	028	0		29	10	S5820_028_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	029	0		29	10	S5820_029_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	029	0		29	10	S5820_029_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.10	204.30								68.10							189.30			204.30			3
S5820	029	0		29	10	S5820_029_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	029	0		29	10	S5820_029_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	030	0		29	10	S5820_030_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	030	0		29	10	S5820_030_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	030	0		29	10	S5820_030_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	61.95	185.85								61.95							170.85			185.85			3
S5820	030	0		29	10	S5820_030_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	031	0		29	10	S5820_031_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	031	0		29	10	S5820_031_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.70	206.10								68.70							191.10			206.10			3
S5820	031	0		29	10	S5820_031_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	031	0		29	10	S5820_031_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	032	0		29	10	S5820_032_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	032	0		29	10	S5820_032_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	032	0		29	10	S5820_032_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	72.35	217.05								72.35							202.05			217.05			3
S5820	032	0		29	10	S5820_032_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	033	0		29	10	S5820_033_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	033	0		29	10	S5820_033_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	033	0		29	10	S5820_033_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	033	0		29	10	S5820_033_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	69.90	209.70								69.90							194.70			209.70			3
S5820	034	0		29	10	S5820_034_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	034	0		29	10	S5820_034_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	034	0		29	10	S5820_034_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	034	0		29	10	S5820_034_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			3
S5820	035	0		29	10	S5820_035_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	035	0		29	10	S5820_035_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	035	0		29	10	S5820_035_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			3
S5820	035	0		29	10	S5820_035_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	036	0		29	10	S5820_036_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	036	0		29	10	S5820_036_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	036	0		29	10	S5820_036_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			3
S5820	036	0		29	10	S5820_036_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	037	0		29	10	S5820_037_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	037	0		29	10	S5820_037_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	037	0		29	10	S5820_037_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	037	0		29	10	S5820_037_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			3
S5820	038	0		29	10	S5820_038_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			3
S5820	038	0		29	10	S5820_038_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			3
S5820	038	0		29	10	S5820_038_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			3
S5820	038	0		29	10	S5820_038_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5820	105	0		29	10	S5820_105_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	105	0		29	10	S5820_105_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	105	0		29	10	S5820_105_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	105	0		29	10	S5820_105_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	106	0		29	10	S5820_106_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	106	0		29	10	S5820_106_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	106	0		29	10	S5820_106_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	106	0		29	10	S5820_106_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	107	0		29	10	S5820_107_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	107	0		29	10	S5820_107_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	107	0		29	10	S5820_107_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	107	0		29	10	S5820_107_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	108	0		29	10	S5820_108_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	108	0		29	10	S5820_108_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	108	0		29	10	S5820_108_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	108	0		29	10	S5820_108_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	109	0		29	10	S5820_109_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	109	0		29	10	S5820_109_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	109	0		29	10	S5820_109_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	109	0		29	10	S5820_109_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	110	0		29	10	S5820_110_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	110	0		29	10	S5820_110_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	110	0		29	10	S5820_110_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	110	0		29	10	S5820_110_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	111	0		29	10	S5820_111_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	111	0		29	10	S5820_111_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	111	0		29	10	S5820_111_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	111	0		29	10	S5820_111_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	112	0		29	10	S5820_112_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	112	0		29	10	S5820_112_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	112	0		29	10	S5820_112_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	112	0		29	10	S5820_112_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	113	0		29	10	S5820_113_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	113	0		29	10	S5820_113_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	113	0		29	10	S5820_113_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	113	0		29	10	S5820_113_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	114	0		29	10	S5820_114_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	114	0		29	10	S5820_114_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	114	0		29	10	S5820_114_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	114	0		29	10	S5820_114_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	115	0		29	10	S5820_115_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	115	0		29	10	S5820_115_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	115	0		29	10	S5820_115_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	115	0		29	10	S5820_115_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	116	0		29	10	S5820_116_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	116	0		29	10	S5820_116_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	116	0		29	10	S5820_116_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	116	0		29	10	S5820_116_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	117	0		29	10	S5820_117_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	117	0		29	10	S5820_117_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	117	0		29	10	S5820_117_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	117	0		29	10	S5820_117_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	118	0		29	10	S5820_118_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	118	0		29	10	S5820_118_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	118	0		29	10	S5820_118_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	118	0		29	10	S5820_118_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	119	0		29	10	S5820_119_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	119	0		29	10	S5820_119_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	119	0		29	10	S5820_119_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	119	0		29	10	S5820_119_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	120	0		29	10	S5820_120_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	120	0		29	10	S5820_120_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	120	0		29	10	S5820_120_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	120	0		29	10	S5820_120_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	121	0		29	10	S5820_121_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	121	0		29	10	S5820_121_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	121	0		29	10	S5820_121_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	121	0		29	10	S5820_121_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	122	0		29	10	S5820_122_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	122	0		29	10	S5820_122_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	122	0		29	10	S5820_122_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	122	0		29	10	S5820_122_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	123	0		29	10	S5820_123_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	123	0		29	10	S5820_123_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	123	0		29	10	S5820_123_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	123	0		29	10	S5820_123_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	124	0		29	10	S5820_124_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	124	0		29	10	S5820_124_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	124	0		29	10	S5820_124_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	124	0		29	10	S5820_124_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	125	0		29	10	S5820_125_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	125	0		29	10	S5820_125_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	125	0		29	10	S5820_125_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	125	0		29	10	S5820_125_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	126	0		29	10	S5820_126_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	126	0		29	10	S5820_126_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	126	0		29	10	S5820_126_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	126	0		29	10	S5820_126_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	127	0		29	10	S5820_127_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	127	0		29	10	S5820_127_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	127	0		29	10	S5820_127_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	127	0		29	10	S5820_127_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	128	0		29	10	S5820_128_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	128	0		29	10	S5820_128_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	128	0		29	10	S5820_128_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	128	0		29	10	S5820_128_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	129	0		29	10	S5820_129_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	129	0		29	10	S5820_129_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	129	0		29	10	S5820_129_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	129	0		29	10	S5820_129_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	130	0		29	10	S5820_130_0	3	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	130	0		29	10	S5820_130_0	3	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	130	0		29	10	S5820_130_0	3	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	130	0		29	10	S5820_130_0	3	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	131	0		29	10	S5820_131_0	2	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	131	0		29	10	S5820_131_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	131	0		29	10	S5820_131_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	131	0		29	10	S5820_131_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	132	0		29	10	S5820_132_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	132	0		29	10	S5820_132_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	132	0		29	10	S5820_132_0	2	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	132	0		29	10	S5820_132_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	133	0		29	10	S5820_133_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	133	0		29	10	S5820_133_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	133	0		29	10	S5820_133_0	2	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	133	0		29	10	S5820_133_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	134	0		29	10	S5820_134_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	134	0		29	10	S5820_134_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	134	0		29	10	S5820_134_0	2	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	134	0		29	10	S5820_134_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	135	0		29	10	S5820_135_0	2	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	135	0		29	10	S5820_135_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	135	0		29	10	S5820_135_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	135	0		29	10	S5820_135_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	136	0		29	10	S5820_136_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	136	0		29	10	S5820_136_0	2	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	136	0		29	10	S5820_136_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	136	0		29	10	S5820_136_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	137	0		29	10	S5820_137_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	25.00	75.00								25.00							60.00			75.00			4
S5820	137	0		29	10	S5820_137_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			4
S5820	137	0		29	10	S5820_137_0	2	3	1	Tier 3 Non Preferred	000010	3	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	50.00	150.00								50.00							135.00			150.00			4
S5820	137	0		29	10	S5820_137_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	142	0		29	10	S5820_142_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5820	142	0		29	10	S5820_142_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5820	142	0		29	10	S5820_142_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5820	142	0		29	10	S5820_142_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5820	142	0		29	10	S5820_142_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5820	142	0		29	10	S5820_142_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5820	142	0		29	10	S5820_142_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	142	0		29	10	S5820_142_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			4
S5820	143	0		29	10	S5820_143_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5820	143	0		29	10	S5820_143_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5820	143	0		29	10	S5820_143_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5820	143	0		29	10	S5820_143_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5820	143	0		29	10	S5820_143_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	143	0		29	10	S5820_143_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			4
S5820	143	0		29	10	S5820_143_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5820	143	0		29	10	S5820_143_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5820	144	0		29	10	S5820_144_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5820	144	0		29	10	S5820_144_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5820	144	0		29	10	S5820_144_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			4
S5820	144	0		29	10	S5820_144_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	144	0		29	10	S5820_144_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5820	144	0		29	10	S5820_144_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5820	144	0		29	10	S5820_144_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5820	144	0		29	10	S5820_144_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5820	145	0		29	10	S5820_145_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5820	145	0		29	10	S5820_145_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5820	145	0		29	10	S5820_145_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5820	145	0		29	10	S5820_145_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5820	145	0		29	10	S5820_145_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5820	145	0		29	10	S5820_145_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			4
S5820	145	0		29	10	S5820_145_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	145	0		29	10	S5820_145_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5820	146	0		29	10	S5820_146_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5820	146	0		29	10	S5820_146_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5820	146	0		29	10	S5820_146_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5820	146	0		29	10	S5820_146_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5820	146	0		29	10	S5820_146_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5820	146	0		29	10	S5820_146_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5820	146	0		29	10	S5820_146_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.35	202.05								67.35							187.05			202.05			4
S5820	146	0		29	10	S5820_146_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5820	147	0		29	10	S5820_147_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5820	147	0		29	10	S5820_147_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	33.60	100.80								33.60							85.80			100.80			2
S5820	147	0		29	10	S5820_147_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5820	147	0		29	10	S5820_147_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5820	148	0		29	10	S5820_148_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5820	148	0		29	10	S5820_148_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5820	148	0		29	10	S5820_148_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	33.60	100.80								33.60							85.80			100.80			2
S5820	148	0		29	10	S5820_148_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5820	149	0		29	10	S5820_149_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	33.60	100.80								33.60							85.80			100.80			2
S5820	149	0		29	10	S5820_149_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5820	149	0		29	10	S5820_149_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5820	149	0		29	10	S5820_149_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5820	150	0		29	10	S5820_150_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5820	150	0		29	10	S5820_150_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5820	150	0		29	10	S5820_150_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	33.60	100.80								33.60							85.80			100.80			2
S5820	150	0		29	10	S5820_150_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5820	151	0		29	10	S5820_151_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5820	151	0		29	10	S5820_151_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5820	151	0		29	10	S5820_151_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5820	151	0		29	10	S5820_151_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	33.60	100.80								33.60							85.80			100.80			2
S5822	004	0		29	10	S5822_004_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S5822	004	0		29	10	S5822_004_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00	96.00		32.00	64.00									3
S5822	004	0		29	10	S5822_004_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	62.00	186.00								62.00	186.00		62.00	124.00									3
S5822	004	0		29	10	S5822_004_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5822	006	0		29	10	S5822_006_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	63.00	189.00								63.00	188.00		63.00	126.00									3
S5822	006	0		29	10	S5822_006_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S5822	006	0		29	10	S5822_006_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00		33.00	66.00									3
S5822	006	0		29	10	S5822_006_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5825	017	0		29	10	S5825_017_0	1	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5825	017	0		29	10	S5825_017_0	1	2	1	Brand	000010	1	2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	37.00	74.00								37.00				74.00									4
S5825	017	0		29	10	S5825_017_0	1	3	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5825	085	0		29	10	S5825_085_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	60.00	120.00								60.00				120.00									4
S5825	085	0		29	10	S5825_085_0	2	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5825	085	0		29	10	S5825_085_0	2	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00									4
S5825	085	0		29	10	S5825_085_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5825	085	0		29	10	S5825_085_0	2	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	34									34												Specialty	2	1	010000000010000000000		Specialty	33									33												Specialty																							4
S5825	085	0		29	10	S5825_085_0	2	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	7.00	14.00								7.00				14.00								1	4
S5825	085	0		29	10	S5825_085_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5825	085	0		29	10	S5825_085_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	31.00	62.00								31.00				62.00									4
S5840	002	0		29	10	S5840_002_0	2	1	1	Generic	010000	1	2	Generic	010000000010000000000	30									30												Generic	2	2		010000000010000000000	Generic																						Generic	5.00									5.00													4
S5840	002	0		29	10	S5840_002_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	010000000010000000000	30									30												Preferred Brand	2	1	010000000010000000000		Preferred Brand	20									20												Preferred Brand																							4
S5840	002	0		29	10	S5840_002_0	2	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	1	010000000010000000000		Non-Preferred Brand	30									30												Non-Preferred Brand																							4
S5840	002	0		29	10	S5840_002_0	2	4	3	Specialty Drugs	010001	1	1	Specialty Drugs																							Specialty Drugs					Specialty Drugs																						Specialty Drugs																						2	4
S5840	002	0		29	10	S5840_002_0	2	1	3	Generic	010000	1	2	Generic	010000000010000000000	30									30												Generic	2	2		010000000010000000000	Generic																						Generic	5.00									5.00												1	4
S5840	002	0		29	10	S5840_002_0	2	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5840	002	0		29	10	S5840_002_0	2	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5840	002	0		29	10	S5840_002_0	2	4	1	Specialty Drugs	010001	1	1	Specialty Drugs	010000000010000000000	30									30												Specialty Drugs	2	1	010000000010000000000		Specialty Drugs	33									33												Specialty Drugs																							4
S5857	001	0		29	10	S5857_001_0	1	1	1	Generic On Formulary	010000		2	Generic On Formulary	011000000011001000000	31	90								31	90			90								Generic On Formulary	2	2		011000000011001000000	Generic On Formulary																						Generic On Formulary	10.00	30.00								10.00	30.00			20.00									3
S5857	001	0		29	10	S5857_001_0	1	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	31	90								31	90			90								Non-Preferred Brand	2	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	67.00	201.00								67.00	201.00			134.00									3
S5857	001	0		29	10	S5857_001_0	1	2	1	Preferred Brand on Formulary	000001		2	Preferred Brand on Formulary	011000000011001000000	31	90								31	90			90								Preferred Brand on Formulary	2	2		011000000011001000000	Preferred Brand on Formulary																						Preferred Brand on Formulary	39.00	117.00								39.00	117.00			78.00									3
S5860	002	0		29	10	S5860_002_0	1	1	1	Generic	011100	1	2	Generic	011000000011001000000	31	90								31	90			90								Generic	2	2		011000000011001000000	Generic																						Generic	15.00	45.00								15.00	45.00			30.00									4
S5860	002	0		29	10	S5860_002_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	31	90								31	90			90								Preferred Brand	2	1	011000000011001000000		Preferred Brand	30	30								30	30			30								Preferred Brand																							4
S5860	002	0		29	10	S5860_002_0	1	5	1	Injectables	010010	1	1	Injectables	011000000011001000000	31	90								31	90			90								Injectables	2	1	011000000011001000000		Injectables	25	25								25	25			25								Injectables																							4
S5860	002	0		29	10	S5860_002_0	1	4	1	Specialty	010010	1	1	Specialty	011000000011001000000	31	90								31	90			90								Specialty	2	1	011000000011001000000		Specialty	25	25								25	25			25								Specialty																							4
S5860	002	0		29	10	S5860_002_0	1	3	1	Brand	100010	1	2	Brand	011000000011001000000	31	90								31	90			90								Brand	2	1	011000000011001000000		Brand	30	30								30	30			30								Brand																							4
S5877	004	0		29	10	S5877_004_0	3	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	40.00	120.00								40.00				120.00									2
S5877	004	0		29	10	S5877_004_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	25.00	75.00								25.00				75.00									2
S5877	004	0		29	10	S5877_004_0	3	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	2.00	6.00								2.00				6.00									2
S5877	004	0		29	10	S5877_004_0	3	4	1	Specialty	010010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	2		011000000010001000000	Specialty																						Specialty	40.00	120.00								40.00				120.00									2
S5877	007	0		29	10	S5877_007_0	3	4	1	Specialty	010010	1	1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	30	30								30				30								Specialty																							4
S5877	007	0		29	10	S5877_007_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	1	011000000010001000000		Non-Preferred Brand	50	50								50				50								Non-Preferred Brand																							4
S5877	007	0		29	10	S5877_007_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	1	011000000010001000000		Preferred Brand	25	25								25				25								Preferred Brand																							4
S5877	007	0		29	10	S5877_007_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	1	011000000010001000000		Generic	20	20								20				20								Generic																							4
S5877	008	0		29	10	S5877_008_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	1	011000000010001000000		Non-Preferred Brand	50	50								50				50								Non-Preferred Brand																							4
S5877	008	0		29	10	S5877_008_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	1	011000000010001000000		Preferred Brand	25	25								25				25								Preferred Brand																							4
S5877	008	0		29	10	S5877_008_0	3	1	1	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	1	011000000010001000000		Generic	20	20								20				20								Generic																							4
S5877	008	0		29	10	S5877_008_0	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5877	008	0		29	10	S5877_008_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5877	008	0		29	10	S5877_008_0	3	4	1	Specialty	010010	1	1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	30	30								30				30								Specialty																							4
S5877	008	0		29	10	S5877_008_0	3	1	3	Generic	010000	1	2	Generic	011000000010001000000	34	90								34				90								Generic	2	1	011000000010001000000		Generic	20	20								20				20								Generic																						1	4
S5877	008	0		29	10	S5877_008_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	001	0		29	10	S5884_001_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	001	0		29	10	S5884_001_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	001	0		29	10	S5884_001_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	001	0		29	10	S5884_001_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	002	0		29	10	S5884_002_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	002	0		29	10	S5884_002_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	002	0		29	10	S5884_002_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	002	0		29	10	S5884_002_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	003	0		29	10	S5884_003_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	003	0		29	10	S5884_003_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	003	0		29	10	S5884_003_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	003	0		29	10	S5884_003_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	004	0		29	10	S5884_004_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	004	0		29	10	S5884_004_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	004	0		29	10	S5884_004_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	004	0		29	10	S5884_004_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	005	0		29	10	S5884_005_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	005	0		29	10	S5884_005_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	005	0		29	10	S5884_005_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	005	0		29	10	S5884_005_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	006	0		29	10	S5884_006_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	006	0		29	10	S5884_006_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	006	0		29	10	S5884_006_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	006	0		29	10	S5884_006_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	007	0		29	10	S5884_007_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	007	0		29	10	S5884_007_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	007	0		29	10	S5884_007_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	007	0		29	10	S5884_007_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	008	0		29	10	S5884_008_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	008	0		29	10	S5884_008_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	008	0		29	10	S5884_008_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	008	0		29	10	S5884_008_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	009	0		29	10	S5884_009_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	009	0		29	10	S5884_009_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	009	0		29	10	S5884_009_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	009	0		29	10	S5884_009_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	010	0		29	10	S5884_010_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	010	0		29	10	S5884_010_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	010	0		29	10	S5884_010_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	010	0		29	10	S5884_010_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	011	0		29	10	S5884_011_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	011	0		29	10	S5884_011_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	011	0		29	10	S5884_011_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	011	0		29	10	S5884_011_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	012	0		29	10	S5884_012_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	012	0		29	10	S5884_012_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	012	0		29	10	S5884_012_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	012	0		29	10	S5884_012_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	013	0		29	10	S5884_013_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	013	0		29	10	S5884_013_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	013	0		29	10	S5884_013_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	013	0		29	10	S5884_013_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	014	0		29	10	S5884_014_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	014	0		29	10	S5884_014_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	014	0		29	10	S5884_014_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	014	0		29	10	S5884_014_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	015	0		29	10	S5884_015_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	015	0		29	10	S5884_015_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	015	0		29	10	S5884_015_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	015	0		29	10	S5884_015_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	016	0		29	10	S5884_016_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	016	0		29	10	S5884_016_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	016	0		29	10	S5884_016_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	016	0		29	10	S5884_016_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	017	0		29	10	S5884_017_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	017	0		29	10	S5884_017_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	017	0		29	10	S5884_017_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	017	0		29	10	S5884_017_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	018	0		29	10	S5884_018_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	018	0		29	10	S5884_018_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	018	0		29	10	S5884_018_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	018	0		29	10	S5884_018_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	019	0		29	10	S5884_019_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	019	0		29	10	S5884_019_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	019	0		29	10	S5884_019_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	019	0		29	10	S5884_019_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	020	0		29	10	S5884_020_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	020	0		29	10	S5884_020_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	020	0		29	10	S5884_020_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	020	0		29	10	S5884_020_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	021	0		29	10	S5884_021_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	021	0		29	10	S5884_021_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	021	0		29	10	S5884_021_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	021	0		29	10	S5884_021_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	022	0		29	10	S5884_022_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	022	0		29	10	S5884_022_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	022	0		29	10	S5884_022_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	022	0		29	10	S5884_022_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	023	0		29	10	S5884_023_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	023	0		29	10	S5884_023_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	023	0		29	10	S5884_023_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	023	0		29	10	S5884_023_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	024	0		29	10	S5884_024_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	024	0		29	10	S5884_024_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	024	0		29	10	S5884_024_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	024	0		29	10	S5884_024_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	025	0		29	10	S5884_025_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	025	0		29	10	S5884_025_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	025	0		29	10	S5884_025_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	025	0		29	10	S5884_025_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	026	0		29	10	S5884_026_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	026	0		29	10	S5884_026_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	026	0		29	10	S5884_026_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	026	0		29	10	S5884_026_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	027	0		29	10	S5884_027_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	027	0		29	10	S5884_027_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	027	0		29	10	S5884_027_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	027	0		29	10	S5884_027_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	028	0		29	10	S5884_028_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	028	0		29	10	S5884_028_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	028	0		29	10	S5884_028_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	028	0		29	10	S5884_028_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	029	0		29	10	S5884_029_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	029	0		29	10	S5884_029_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	029	0		29	10	S5884_029_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	029	0		29	10	S5884_029_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	030	0		29	10	S5884_030_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	030	0		29	10	S5884_030_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	030	0		29	10	S5884_030_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	030	0		29	10	S5884_030_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	031	0		29	10	S5884_031_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	031	0		29	10	S5884_031_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	031	0		29	10	S5884_031_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	031	0		29	10	S5884_031_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	031	0		29	10	S5884_031_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	031	0		29	10	S5884_031_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	031	0		29	10	S5884_031_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	031	0		29	10	S5884_031_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	032	0		29	10	S5884_032_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	032	0		29	10	S5884_032_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	032	0		29	10	S5884_032_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	032	0		29	10	S5884_032_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	032	0		29	10	S5884_032_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	032	0		29	10	S5884_032_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	032	0		29	10	S5884_032_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	032	0		29	10	S5884_032_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	033	0		29	10	S5884_033_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	033	0		29	10	S5884_033_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	033	0		29	10	S5884_033_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	033	0		29	10	S5884_033_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	033	0		29	10	S5884_033_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	033	0		29	10	S5884_033_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	033	0		29	10	S5884_033_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	033	0		29	10	S5884_033_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	034	0		29	10	S5884_034_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	034	0		29	10	S5884_034_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	034	0		29	10	S5884_034_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	034	0		29	10	S5884_034_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	034	0		29	10	S5884_034_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	034	0		29	10	S5884_034_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	034	0		29	10	S5884_034_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	034	0		29	10	S5884_034_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	035	0		29	10	S5884_035_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	035	0		29	10	S5884_035_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	035	0		29	10	S5884_035_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	035	0		29	10	S5884_035_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	035	0		29	10	S5884_035_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	035	0		29	10	S5884_035_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	035	0		29	10	S5884_035_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	035	0		29	10	S5884_035_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	036	0		29	10	S5884_036_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	036	0		29	10	S5884_036_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	036	0		29	10	S5884_036_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	036	0		29	10	S5884_036_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	036	0		29	10	S5884_036_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	036	0		29	10	S5884_036_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	036	0		29	10	S5884_036_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	036	0		29	10	S5884_036_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	037	0		29	10	S5884_037_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	037	0		29	10	S5884_037_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	037	0		29	10	S5884_037_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	037	0		29	10	S5884_037_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	037	0		29	10	S5884_037_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	037	0		29	10	S5884_037_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	037	0		29	10	S5884_037_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	037	0		29	10	S5884_037_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	038	0		29	10	S5884_038_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	038	0		29	10	S5884_038_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	038	0		29	10	S5884_038_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	038	0		29	10	S5884_038_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	038	0		29	10	S5884_038_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	038	0		29	10	S5884_038_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	038	0		29	10	S5884_038_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	038	0		29	10	S5884_038_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	039	0		29	10	S5884_039_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	039	0		29	10	S5884_039_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	039	0		29	10	S5884_039_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	039	0		29	10	S5884_039_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	039	0		29	10	S5884_039_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	039	0		29	10	S5884_039_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	039	0		29	10	S5884_039_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	039	0		29	10	S5884_039_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	040	0		29	10	S5884_040_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	040	0		29	10	S5884_040_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	040	0		29	10	S5884_040_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	040	0		29	10	S5884_040_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	040	0		29	10	S5884_040_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	040	0		29	10	S5884_040_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	040	0		29	10	S5884_040_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	040	0		29	10	S5884_040_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	041	0		29	10	S5884_041_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	041	0		29	10	S5884_041_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	041	0		29	10	S5884_041_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	041	0		29	10	S5884_041_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	041	0		29	10	S5884_041_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	041	0		29	10	S5884_041_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	041	0		29	10	S5884_041_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	041	0		29	10	S5884_041_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	042	0		29	10	S5884_042_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	042	0		29	10	S5884_042_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	042	0		29	10	S5884_042_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	042	0		29	10	S5884_042_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	042	0		29	10	S5884_042_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	042	0		29	10	S5884_042_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	042	0		29	10	S5884_042_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	042	0		29	10	S5884_042_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	043	0		29	10	S5884_043_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	043	0		29	10	S5884_043_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	043	0		29	10	S5884_043_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	043	0		29	10	S5884_043_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	043	0		29	10	S5884_043_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	043	0		29	10	S5884_043_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	043	0		29	10	S5884_043_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	043	0		29	10	S5884_043_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	044	0		29	10	S5884_044_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	044	0		29	10	S5884_044_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	044	0		29	10	S5884_044_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	044	0		29	10	S5884_044_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	044	0		29	10	S5884_044_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	044	0		29	10	S5884_044_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	044	0		29	10	S5884_044_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	044	0		29	10	S5884_044_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	045	0		29	10	S5884_045_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	045	0		29	10	S5884_045_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	045	0		29	10	S5884_045_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	045	0		29	10	S5884_045_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	045	0		29	10	S5884_045_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	045	0		29	10	S5884_045_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	045	0		29	10	S5884_045_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	045	0		29	10	S5884_045_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	046	0		29	10	S5884_046_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	046	0		29	10	S5884_046_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	046	0		29	10	S5884_046_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	046	0		29	10	S5884_046_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	046	0		29	10	S5884_046_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	046	0		29	10	S5884_046_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	046	0		29	10	S5884_046_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	046	0		29	10	S5884_046_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	047	0		29	10	S5884_047_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	047	0		29	10	S5884_047_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	047	0		29	10	S5884_047_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	047	0		29	10	S5884_047_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	047	0		29	10	S5884_047_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	047	0		29	10	S5884_047_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	047	0		29	10	S5884_047_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	047	0		29	10	S5884_047_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	048	0		29	10	S5884_048_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	048	0		29	10	S5884_048_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	048	0		29	10	S5884_048_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	048	0		29	10	S5884_048_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	048	0		29	10	S5884_048_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	048	0		29	10	S5884_048_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	048	0		29	10	S5884_048_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	048	0		29	10	S5884_048_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	049	0		29	10	S5884_049_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	049	0		29	10	S5884_049_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	049	0		29	10	S5884_049_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	049	0		29	10	S5884_049_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	049	0		29	10	S5884_049_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	049	0		29	10	S5884_049_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	049	0		29	10	S5884_049_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	049	0		29	10	S5884_049_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	050	0		29	10	S5884_050_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	050	0		29	10	S5884_050_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	050	0		29	10	S5884_050_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	050	0		29	10	S5884_050_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	050	0		29	10	S5884_050_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	050	0		29	10	S5884_050_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	050	0		29	10	S5884_050_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	050	0		29	10	S5884_050_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	051	0		29	10	S5884_051_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	051	0		29	10	S5884_051_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	051	0		29	10	S5884_051_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	051	0		29	10	S5884_051_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	051	0		29	10	S5884_051_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	051	0		29	10	S5884_051_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	051	0		29	10	S5884_051_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	051	0		29	10	S5884_051_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	052	0		29	10	S5884_052_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	052	0		29	10	S5884_052_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	052	0		29	10	S5884_052_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	052	0		29	10	S5884_052_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	052	0		29	10	S5884_052_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	052	0		29	10	S5884_052_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	052	0		29	10	S5884_052_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	052	0		29	10	S5884_052_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	053	0		29	10	S5884_053_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	053	0		29	10	S5884_053_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	053	0		29	10	S5884_053_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	053	0		29	10	S5884_053_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	053	0		29	10	S5884_053_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	053	0		29	10	S5884_053_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	053	0		29	10	S5884_053_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	053	0		29	10	S5884_053_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	054	0		29	10	S5884_054_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	054	0		29	10	S5884_054_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	054	0		29	10	S5884_054_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	054	0		29	10	S5884_054_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	054	0		29	10	S5884_054_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	054	0		29	10	S5884_054_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	054	0		29	10	S5884_054_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	054	0		29	10	S5884_054_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	055	0		29	10	S5884_055_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	055	0		29	10	S5884_055_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	055	0		29	10	S5884_055_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	055	0		29	10	S5884_055_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	055	0		29	10	S5884_055_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	055	0		29	10	S5884_055_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	055	0		29	10	S5884_055_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	055	0		29	10	S5884_055_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	056	0		29	10	S5884_056_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	056	0		29	10	S5884_056_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	056	0		29	10	S5884_056_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	056	0		29	10	S5884_056_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	056	0		29	10	S5884_056_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	056	0		29	10	S5884_056_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	056	0		29	10	S5884_056_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	056	0		29	10	S5884_056_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	057	0		29	10	S5884_057_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	057	0		29	10	S5884_057_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	057	0		29	10	S5884_057_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	057	0		29	10	S5884_057_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	057	0		29	10	S5884_057_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	057	0		29	10	S5884_057_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	057	0		29	10	S5884_057_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	057	0		29	10	S5884_057_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	058	0		29	10	S5884_058_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	058	0		29	10	S5884_058_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	058	0		29	10	S5884_058_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	058	0		29	10	S5884_058_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	058	0		29	10	S5884_058_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	058	0		29	10	S5884_058_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	058	0		29	10	S5884_058_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	058	0		29	10	S5884_058_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	059	0		29	10	S5884_059_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	059	0		29	10	S5884_059_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	059	0		29	10	S5884_059_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	059	0		29	10	S5884_059_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	059	0		29	10	S5884_059_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	059	0		29	10	S5884_059_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	059	0		29	10	S5884_059_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	059	0		29	10	S5884_059_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	060	0		29	10	S5884_060_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	060	0		29	10	S5884_060_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	060	0		29	10	S5884_060_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	060	0		29	10	S5884_060_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	060	0		29	10	S5884_060_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	060	0		29	10	S5884_060_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	060	0		29	10	S5884_060_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	060	0		29	10	S5884_060_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	095	0		29	10	S5884_095_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	095	0		29	10	S5884_095_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	095	0		29	10	S5884_095_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	095	0		29	10	S5884_095_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	096	0		29	10	S5884_096_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	096	0		29	10	S5884_096_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	096	0		29	10	S5884_096_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	096	0		29	10	S5884_096_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	097	0		29	10	S5884_097_0	2	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	097	0		29	10	S5884_097_0	2	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	097	0		29	10	S5884_097_0	2	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	097	0		29	10	S5884_097_0	2	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	098	0		29	10	S5884_098_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	098	0		29	10	S5884_098_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	098	0		29	10	S5884_098_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	098	0		29	10	S5884_098_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	098	0		29	10	S5884_098_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	098	0		29	10	S5884_098_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	098	0		29	10	S5884_098_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	098	0		29	10	S5884_098_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	099	0		29	10	S5884_099_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	099	0		29	10	S5884_099_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	099	0		29	10	S5884_099_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	099	0		29	10	S5884_099_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	099	0		29	10	S5884_099_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5884	099	0		29	10	S5884_099_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	099	0		29	10	S5884_099_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	099	0		29	10	S5884_099_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	100	0		29	10	S5884_100_0	1	1	1	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50									4
S5884	100	0		29	10	S5884_100_0	1	2	1	Preferred Brand	000011	1	2	Preferred Brand	011000000010011000000	30	90								30			30	90								Preferred Brand	2	2		011000000010011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00			30.00	75.00									4
S5884	100	0		29	10	S5884_100_0	1	3	1	Other - Non-Preferred	100100	1	2	Other - Non-Preferred	011000000010011000000	30	90								30			30	90								Other - Non-Preferred	2	2		011000000010011000000	Other - Non-Preferred																						Other - Non-Preferred	60.00	180.00								60.00			60.00	150.00									4
S5884	100	0		29	10	S5884_100_0	1	4	3	Specialty	100100	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5884	100	0		29	10	S5884_100_0	1	1	3	Preferred Generic	011000	1	2	Preferred Generic	011000000010011000000	30	90								30			30	90								Preferred Generic	2	2		011000000010011000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00			5.00	12.50								1	4
S5884	100	0		29	10	S5884_100_0	1	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5884	100	0		29	10	S5884_100_0	1	3	3	Other - Non-Preferred	100100	1	2	Other - Non-Preferred																							Other - Non-Preferred					Other - Non-Preferred																						Other - Non-Preferred																						2	4
S5884	100	0		29	10	S5884_100_0	1	4	1	Specialty	100100	1	1	Specialty	010000000010010000000	30									30			30									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							4
S5902	001	0		29	10	S5902_001_0	4	3	1	Non-Preferred	100100		2	Non-Preferred	011000000011001000000	30	90								30	90			90								Non-Preferred	1	2		011000000011001000000	Non-Preferred																						Non-Preferred	55.00	165.00								55.00	165.00			165.00									3
S5902	001	0		29	10	S5902_001_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			83.00									3
S5902	001	0		29	10	S5902_001_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000011001000000	30	90								30	90			90								Preferred Generic	2	2		011000000011001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00	12.00			8.00									3
S5902	001	0		29	10	S5902_001_0	4	4	1	Specialty	010010		1	Specialty	010000000010000000000	30									30												Specialty	1	2		010000000010000000000	Specialty																						Specialty	100.00									100.00													3
S5902	002	0		29	10	S5902_002_0	3	1	3	Preferred Generic	001000	1	2	Preferred Generic	011000000011001000000	30	90								30	90			90								Preferred Generic	2	2		011000000011001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00	12.00			8.00								1	4
S5902	002	0		29	10	S5902_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5902	002	0		29	10	S5902_002_0	3	3	3	Non-Preferred	100100	1	2	Non-Preferred																							Non-Preferred					Non-Preferred																						Non-Preferred																						2	4
S5902	002	0		29	10	S5902_002_0	3	4	1	Specialty	010010	1	1	Specialty	010000000010000000000	30									30												Specialty	1	2		010000000010000000000	Specialty																						Specialty	100.00									100.00													4
S5902	002	0		29	10	S5902_002_0	3	3	1	Non-Preferred	100100	1	2	Non-Preferred	011000000011001000000	30	90								30	90			90								Non-Preferred	1	2		011000000011001000000	Non-Preferred																						Non-Preferred	55.00	165.00								55.00	165.00			165.00									4
S5902	002	0		29	10	S5902_002_0	3	4	3	Specialty	010010	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5902	002	0		29	10	S5902_002_0	3	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000011001000000	30	90								30	90			90								Preferred Generic	2	2		011000000011001000000	Preferred Generic																						Preferred Generic	4.00	12.00								4.00	12.00			8.00									4
S5902	002	0		29	10	S5902_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00			83.00									4
S5904	001	0		29	10	S5904_001_0	4	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
S5904	001	0		29	10	S5904_001_0	4	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 2 Preferred Brand	2	2		011100000011111100000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	25.00	75.00	50.00							25.00	75.00	50.00	25.00	75.00	50.00								4
S5904	001	0		29	10	S5904_001_0	4	5	1	Excluded Generic	010000	2	2	Excluded Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Excluded Generic	2	2		011100000011111100000	Excluded Generic																						Excluded Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
S5904	001	0		29	10	S5904_001_0	4	4	1	Tier 4 Specialty	110001	1	1	Tier 4 Specialty	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 4 Specialty	2	1	011100000011111100000		Tier 4 Specialty	25	25	25							25	25	25	25	25	25							Tier 4 Specialty																							4
S5904	001	0		29	10	S5904_001_0	4	3	1	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 3 Non-Preferred Brand	2	2		011100000011111100000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
S5904	002	0		29	10	S5904_002_0	3	1	1	Tier 1 Generic	010000	1	2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
S5904	002	0		29	10	S5904_002_0	3	5	3	Excluded Generic	010000	2	2	Excluded Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Excluded Generic	2	2		011100000011111100000	Excluded Generic																						Excluded Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00							1	4
S5904	002	0		29	10	S5904_002_0	3	4	3	Tier 4 Specialty	110001	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5904	002	0		29	10	S5904_002_0	3	3	3	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand																							Tier 3 Non-Preferred Brand					Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand																						2	4
S5904	002	0		29	10	S5904_002_0	3	2	1	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 2 Preferred Brand	2	2		011100000011111100000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	25.00	75.00	50.00							25.00	75.00	50.00	25.00	75.00	50.00								4
S5904	002	0		29	10	S5904_002_0	3	1	3	Tier 1 Generic	010000	1	2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00							1	4
S5904	002	0		29	10	S5904_002_0	3	3	1	Tier 3 Non-Preferred Brand	100000	1	2	Tier 3 Non-Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 3 Non-Preferred Brand	2	2		011100000011111100000	Tier 3 Non-Preferred Brand																						Tier 3 Non-Preferred Brand	40.00	120.00	80.00							40.00	120.00	80.00	40.00	120.00	80.00								4
S5904	002	0		29	10	S5904_002_0	3	4	1	Tier 4 Specialty	110001	1	1	Tier 4 Specialty	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 4 Specialty	2	1	011100000011111100000		Tier 4 Specialty	25	25	25							25	25	25	25	25	25							Tier 4 Specialty																							4
S5904	002	0		29	10	S5904_002_0	3	5	1	Excluded Generic	010000	2	2	Excluded Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Excluded Generic	2	2		011100000011111100000	Excluded Generic																						Excluded Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								4
S5904	002	0		29	10	S5904_002_0	3	2	3	Tier 2 Preferred Brand	000001	1	2	Tier 2 Preferred Brand																							Tier 2 Preferred Brand					Tier 2 Preferred Brand																						Tier 2 Preferred Brand																						2	4
S5904	003	0		29	10	S5904_003_0	5	3	1	Tier 3 Selected Non-Preferred Brand	100000		2	Tier 3 Selected Non-Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 3 Selected Non-Preferred Brand	2	2		011100000011111100000	Tier 3 Selected Non-Preferred Brand																						Tier 3 Selected Non-Preferred Brand	50.00	150.00	100.00							50.00	150.00	100.00	50.00	150.00	100.00								3
S5904	003	0		29	10	S5904_003_0	5	4	1	Tier 4 Specialty	110001		1	Tier 4 Specialty	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 4 Specialty	2	1	011100000011111100000		Tier 4 Specialty	25	25	25							25	25	25	25	25	25							Tier 4 Specialty																							3
S5904	003	0		29	10	S5904_003_0	5	2	1	Tier 2 Preferred Brand	000001		2	Tier 2 Preferred Brand	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 2 Preferred Brand	2	2		011100000011111100000	Tier 2 Preferred Brand																						Tier 2 Preferred Brand	25.00	75.00	50.00							25.00	75.00	50.00	25.00	75.00	50.00								3
S5904	003	0		29	10	S5904_003_0	5	1	1	Tier 1 Generic	010000		2	Tier 1 Generic	011100000011111100000	31	90	60							31	90	60	31	90	60							Tier 1 Generic	2	2		011100000011111100000	Tier 1 Generic																						Tier 1 Generic	5.00	15.00	10.00							5.00	15.00	10.00	5.00	15.00	10.00								3
S5907	001	0		29	10	S5907_001_0	4	1	1	Generic	010000		2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	5.00	15.00	5.00							5.00	15.00	5.00		15.00									3
S5907	001	0		29	10	S5907_001_0	4	2	1	Preferred Brand	000011		2	Preferred Brand	011100000011101000000	30	90	15							30	90	15		90								Preferred Brand	2	2		011100000011101000000	Preferred Brand																						Preferred Brand	18.00	54.00	18.00							18.00	54.00	18.00		54.00									3
S5907	001	0		29	10	S5907_001_0	4	3	1	Brand	010010		2	Brand	011100000011101000000	30	90	15							30	90	15		90								Brand	1	2		011100000011101000000	Brand																						Brand	25.00	75.00	25.00							25.00	75.00	25.00		75.00									3
S5907	001	0		29	10	S5907_001_0	4	4	1	Non Preferred Drugs	100100		2	Non Preferred Drugs	011100000011101000000	30	90	15							30	90	15		90								Non Preferred Drugs	1	3	011100000011101000000	011100000011101000000	Non Preferred Drugs	25	25	25							25	25	25		25								Non Preferred Drugs	25.00	75.00	25.00							25.00	75.00	25.00		75.00									3
S5907	002	0		29	10	S5907_002_0	4	2	1	Preferred Brand	000011		2	Preferred Brand	011100000011101000000	30	90	15							30	90	15		90								Preferred Brand	2	2		011100000011101000000	Preferred Brand																						Preferred Brand	30.00	90.00	30.00							30.00	90.00	30.00		90.00									3
S5907	002	0		29	10	S5907_002_0	4	3	1	Brand	010010		2	Brand	011100000011101000000	30	90	15							30	90	15		90								Brand	1	2		011100000011101000000	Brand																						Brand	50.00	150.00	50.00							50.00	150.00	50.00		150.00									3
S5907	002	0		29	10	S5907_002_0	4	4	1	Non Preferred Drugs	100100		2	Non Preferred Drugs	011100000011101000000	30	90	15							30	90	15		90								Non Preferred Drugs	1	3	011100000011101000000	011100000011101000000	Non Preferred Drugs	25	25	25							25	25	25		25								Non Preferred Drugs	50.00	150.00	50.00							50.00	150.00	50.00		150.00									3
S5907	002	0		29	10	S5907_002_0	4	1	1	Generic	010000		2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	0.00	0.00	0.00							0.00	0.00	0.00		0.00									3
S5907	003	0		29	10	S5907_003_0	3	3	1	Brand	010010	1	2	Brand	011100000011101000000	30	90	15							30	90	15		90								Brand	1	2		011100000011101000000	Brand																						Brand	45.00	135.00	45.00							45.00	135.00	45.00		135.00									4
S5907	003	0		29	10	S5907_003_0	3	4	1	Non Preferred Drugs	100100	1	2	Non Preferred Drugs	011100000011101000000	30	90	15							30	90	15		90								Non Preferred Drugs	1	3	011100000011101000000	011100000011101000000	Non Preferred Drugs	25	25	25							25	25	25		25								Non Preferred Drugs	45.00	135.00	45.00							45.00	135.00	45.00		135.00									4
S5907	003	0		29	10	S5907_003_0	3	1	3	Generic	010000	1	2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	5.00	15.00	5.00							5.00	15.00	5.00		15.00								1	4
S5907	003	0		29	10	S5907_003_0	3	1	1	Generic	010000	1	2	Generic	011100000011101000000	30	90	15							30	90	15		90								Generic	1	2		011100000011101000000	Generic																						Generic	5.00	15.00	5.00							5.00	15.00	5.00		15.00									4
S5907	003	0		29	10	S5907_003_0	3	4	3	Non Preferred Drugs	100100	1	2	Non Preferred Drugs																							Non Preferred Drugs					Non Preferred Drugs																						Non Preferred Drugs																						2	4
S5907	003	0		29	10	S5907_003_0	3	2	1	Preferred Brand	000011	1	2	Preferred Brand	011100000011101000000	30	90	15							30	90	15		90								Preferred Brand	2	2		011100000011101000000	Preferred Brand																						Preferred Brand	25.00	75.00	25.00							25.00	75.00	25.00		75.00									4
S5907	003	0		29	10	S5907_003_0	3	2	3	Preferred Brand	000011	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5907	003	0		29	10	S5907_003_0	3	3	3	Brand	010010	1	2	Brand																							Brand					Brand																						Brand																						2	4
S5915	001	0		29	10	S5915_001_0	1	4	1	Non-preferred Brands and Non-preferred Generics	100100		2	Non-preferred Brands and Non-preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-preferred Brands and Non-preferred Generics	2	2		011100000010011000000	Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics	80.00	240.00	160.00							80.00			80.00	160.00									3
S5915	001	0		29	10	S5915_001_0	1	3	1	Generics and Brands	010010		2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	55.00	165.00	110.00							55.00			55.00	110.00									3
S5915	001	0		29	10	S5915_001_0	1	2	1	Preferred Brands	000001		2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	35.00	105.00	70.00							35.00			35.00	70.00									3
S5915	001	0		29	10	S5915_001_0	1	1	1	Preferred Generics	001000		2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	8.00	24.00	16.00							8.00			8.00	16.00									3
S5915	001	0		29	10	S5915_001_0	1	5	1	Specialty	111111		1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							3
S5915	002	0		29	10	S5915_002_0	3	4	1	Non-preferred Brands and Non-preferred Generics	100100	1	2	Non-preferred Brands and Non-preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-preferred Brands and Non-preferred Generics	2	2		011100000010011000000	Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics	75.00	225.00	150.00							75.00			75.00	150.00									4
S5915	002	0		29	10	S5915_002_0	3	3	1	Generics and Brands	010010	1	2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	45.00	135.00	90.00							45.00			45.00	90.00									4
S5915	002	0		29	10	S5915_002_0	3	2	1	Preferred Brands	000001	1	2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	25.00	75.00	50.00							25.00			25.00	50.00									4
S5915	002	0		29	10	S5915_002_0	3	1	1	Preferred Generics	001000	1	2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	0.00	0.00	0.00							0.00			0.00	0.00									4
S5915	002	0		29	10	S5915_002_0	3	5	1	Specialty	111111	1	1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							4
S5915	002	0		29	10	S5915_002_0	3	5	3	Specialty	111111	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5915	002	0		29	10	S5915_002_0	3	4	3	Non-preferred Brands and Non-preferred Generics	100100	1	2	Non-preferred Brands and Non-preferred Generics																							Non-preferred Brands and Non-preferred Generics					Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics																						2	4
S5915	002	0		29	10	S5915_002_0	3	3	3	Generics and Brands	010010	1	2	Generics and Brands																							Generics and Brands					Generics and Brands																						Generics and Brands																						2	4
S5915	002	0		29	10	S5915_002_0	3	2	3	Preferred Brands	000001	1	2	Preferred Brands																							Preferred Brands					Preferred Brands																						Preferred Brands																						2	4
S5915	002	0		29	10	S5915_002_0	3	1	3	Preferred Generics	001000	1	2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	8.00	24.00	16.00							8.00			8.00	16.00								1	4
S5915	003	0		29	10	S5915_003_0	4	3	1	Generics and Brands	010010		2	Generics and Brands	011100000010011000000	30	90	60							30			30	90								Generics and Brands	2	2		011100000010011000000	Generics and Brands																						Generics and Brands	60.00	180.00	120.00							60.00			60.00	120.00									3
S5915	003	0		29	10	S5915_003_0	4	2	1	Preferred Brands	000001		2	Preferred Brands	011100000010011000000	30	90	60							30			30	90								Preferred Brands	2	2		011100000010011000000	Preferred Brands																						Preferred Brands	20.00	60.00	40.00							20.00			20.00	40.00									3
S5915	003	0		29	10	S5915_003_0	4	1	1	Preferred Generics	001000		2	Preferred Generics	011100000010011000000	30	90	60							30			30	90								Preferred Generics	2	2		011100000010011000000	Preferred Generics																						Preferred Generics	5.00	15.00	10.00							5.00			5.00	10.00									3
S5915	003	0		29	10	S5915_003_0	4	4	1	Non-preferred Brands and Non-preferred Generics	100100		2	Non-preferred Brands and Non-preferred Generics	011100000010011000000	30	90	60							30			30	90								Non-preferred Brands and Non-preferred Generics	2	2		011100000010011000000	Non-preferred Brands and Non-preferred Generics																						Non-preferred Brands and Non-preferred Generics	80.00	240.00	160.00							80.00			80.00	160.00									3
S5915	003	0		29	10	S5915_003_0	4	5	1	Specialty	111111		1	Specialty	011100000010011000000	30	90	60							30			30	90								Specialty	2	1	011100000010011000000		Specialty	25	25	25							25			25	25								Specialty																							3
S5916	001	0		29	10	S5916_001_0	3	4	1	Specialty	110001		1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							2
S5916	001	0		29	10	S5916_001_0	3	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				35.00	105.00		35.00			35.00			105.00	105.00									2
S5916	001	0		29	10	S5916_001_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				18.00	54.00		18.00			18.00			54.00	54.00									2
S5916	001	0		29	10	S5916_001_0	3	1	1	Generic	010000		2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									2
S5916	001	0		29	10	S5916_001_0	3	5	1	Miscellaneous Injectable	110001		2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							2
S5916	002	0		29	10	S5916_002_0	3	1	3	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00								1	4
S5916	002	0		29	10	S5916_002_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5916	002	0		29	10	S5916_002_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5916	002	0		29	10	S5916_002_0	3	4	3	Specialty	110001	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5916	002	0		29	10	S5916_002_0	3	5	1	Miscellaneous Injectable	110001	1	2	Miscellaneous Injectable	000010010010010000000				30			30			30			30									Miscellaneous Injectable	2	1	000010010010010000000		Miscellaneous Injectable				25			25			25			25									Miscellaneous Injectable																							4
S5916	002	0		29	10	S5916_002_0	3	4	1	Specialty	110001	1	1	Specialty	000010010010010000000				30			30			30			30									Specialty	2	1	000010010010010000000		Specialty				25			25			25			25									Specialty																							4
S5916	002	0		29	10	S5916_002_0	3	5	3	Miscellaneous Injectable	110001	1	2	Miscellaneous Injectable																							Miscellaneous Injectable					Miscellaneous Injectable																						Miscellaneous Injectable																						2	4
S5916	002	0		29	10	S5916_002_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	000011010010011000000				30	90		30			30			30	90								Preferred Brand	2	2		000011010010011000000	Preferred Brand																						Preferred Brand				25.00	75.00		25.00			25.00			75.00	75.00									4
S5916	002	0		29	10	S5916_002_0	3	1	1	Generic	010000	1	2	Generic	000011010010011000000				30	90		30			30			30	90								Generic	2	2		000011010010011000000	Generic																						Generic				5.00	15.00		5.00			5.00			15.00	15.00									4
S5916	002	0		29	10	S5916_002_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	000011010010011000000				30	90		30			30			30	90								Non-Preferred Brand	2	2		000011010010011000000	Non-Preferred Brand																						Non-Preferred Brand				50.00	150.00		50.00			50.00			150.00	150.00									4
S5917	001	0		29	10	S5917_001_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									3
S5917	001	0		29	10	S5917_001_0	4	3	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							3
S5917	001	0		29	10	S5917_001_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				87.00									3
S5917	002	0		29	10	S5917_002_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				87.00									3
S5917	002	0		29	10	S5917_002_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									3
S5917	002	0		29	10	S5917_002_0	4	3	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							3
S5917	003	0		29	10	S5917_003_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				87.00									3
S5917	003	0		29	10	S5917_003_0	4	3	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							3
S5917	003	0		29	10	S5917_003_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									3
S5917	004	0		29	10	S5917_004_0	3	3	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							3
S5917	004	0		29	10	S5917_004_0	3	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									3
S5917	004	0		29	10	S5917_004_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				87.00									3
S5917	005	0		29	10	S5917_005_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									3
S5917	005	0		29	10	S5917_005_0	4	3	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							3
S5917	005	0		29	10	S5917_005_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				87.00									3
S5917	006	0		29	10	S5917_006_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				87.00									3
S5917	006	0		29	10	S5917_006_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									3
S5917	006	0		29	10	S5917_006_0	4	3	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							3
S5917	007	0		29	10	S5917_007_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				87.00									3
S5917	007	0		29	10	S5917_007_0	4	3	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							3
S5917	007	0		29	10	S5917_007_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									3
S5917	008	0		29	10	S5917_008_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	29.00	87.00								29.00				87.00									3
S5917	008	0		29	10	S5917_008_0	4	3	1	Specialty Drugs	010010		1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	25	25								25				25								Specialty Drugs																							3
S5917	008	0		29	10	S5917_008_0	4	1	1	Preferred Generic	001000		2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	2.00	6.00								2.00				6.00									3
S5917	034	0		29	10	S5917_034_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	034	0		29	10	S5917_034_0	2	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	034	0		29	10	S5917_034_0	2	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	034	0		29	10	S5917_034_0	2	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	034	0		29	10	S5917_034_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	035	0		29	10	S5917_035_0	2	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	035	0		29	10	S5917_035_0	2	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	035	0		29	10	S5917_035_0	2	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	035	0		29	10	S5917_035_0	2	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	035	0		29	10	S5917_035_0	2	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	036	0		29	10	S5917_036_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	036	0		29	10	S5917_036_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	036	0		29	10	S5917_036_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	036	0		29	10	S5917_036_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	036	0		29	10	S5917_036_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	037	0		29	10	S5917_037_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	037	0		29	10	S5917_037_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	037	0		29	10	S5917_037_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	037	0		29	10	S5917_037_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	037	0		29	10	S5917_037_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	039	0		29	10	S5917_039_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	039	0		29	10	S5917_039_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	039	0		29	10	S5917_039_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	039	0		29	10	S5917_039_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	039	0		29	10	S5917_039_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	040	0		29	10	S5917_040_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	040	0		29	10	S5917_040_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	040	0		29	10	S5917_040_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	040	0		29	10	S5917_040_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	040	0		29	10	S5917_040_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	041	0		29	10	S5917_041_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	041	0		29	10	S5917_041_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	041	0		29	10	S5917_041_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	041	0		29	10	S5917_041_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	041	0		29	10	S5917_041_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	042	0		29	10	S5917_042_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	042	0		29	10	S5917_042_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	042	0		29	10	S5917_042_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	042	0		29	10	S5917_042_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	042	0		29	10	S5917_042_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	043	0		29	10	S5917_043_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	043	0		29	10	S5917_043_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	043	0		29	10	S5917_043_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	043	0		29	10	S5917_043_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	043	0		29	10	S5917_043_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	044	0		29	10	S5917_044_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	044	0		29	10	S5917_044_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	044	0		29	10	S5917_044_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	044	0		29	10	S5917_044_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	044	0		29	10	S5917_044_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	045	0		29	10	S5917_045_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	045	0		29	10	S5917_045_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	045	0		29	10	S5917_045_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	045	0		29	10	S5917_045_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	045	0		29	10	S5917_045_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	046	0		29	10	S5917_046_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	046	0		29	10	S5917_046_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	046	0		29	10	S5917_046_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	046	0		29	10	S5917_046_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	046	0		29	10	S5917_046_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	047	0		29	10	S5917_047_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	047	0		29	10	S5917_047_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	047	0		29	10	S5917_047_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	047	0		29	10	S5917_047_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	047	0		29	10	S5917_047_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	048	0		29	10	S5917_048_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	048	0		29	10	S5917_048_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	048	0		29	10	S5917_048_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	048	0		29	10	S5917_048_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	048	0		29	10	S5917_048_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	049	0		29	10	S5917_049_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	049	0		29	10	S5917_049_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	049	0		29	10	S5917_049_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	049	0		29	10	S5917_049_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	049	0		29	10	S5917_049_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	050	0		29	10	S5917_050_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	050	0		29	10	S5917_050_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	050	0		29	10	S5917_050_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	050	0		29	10	S5917_050_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	050	0		29	10	S5917_050_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	051	0		29	10	S5917_051_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	051	0		29	10	S5917_051_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	051	0		29	10	S5917_051_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	051	0		29	10	S5917_051_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	051	0		29	10	S5917_051_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	052	0		29	10	S5917_052_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	052	0		29	10	S5917_052_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	052	0		29	10	S5917_052_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	052	0		29	10	S5917_052_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	052	0		29	10	S5917_052_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	053	0		29	10	S5917_053_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	053	0		29	10	S5917_053_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	053	0		29	10	S5917_053_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	053	0		29	10	S5917_053_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	053	0		29	10	S5917_053_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	054	0		29	10	S5917_054_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	054	0		29	10	S5917_054_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	054	0		29	10	S5917_054_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	054	0		29	10	S5917_054_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	054	0		29	10	S5917_054_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	055	0		29	10	S5917_055_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	055	0		29	10	S5917_055_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	055	0		29	10	S5917_055_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	055	0		29	10	S5917_055_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	055	0		29	10	S5917_055_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	056	0		29	10	S5917_056_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	056	0		29	10	S5917_056_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	056	0		29	10	S5917_056_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	056	0		29	10	S5917_056_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	056	0		29	10	S5917_056_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	057	0		29	10	S5917_057_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	057	0		29	10	S5917_057_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	057	0		29	10	S5917_057_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	057	0		29	10	S5917_057_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5917	057	0		29	10	S5917_057_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	058	0		29	10	S5917_058_0	1	1	1	Preferred Generic	001000	1	2	Preferred Generic	011000000010001000000	30	90								30				90								Preferred Generic	2	2		011000000010001000000	Preferred Generic																						Preferred Generic	5.00	15.00								5.00				15.00									4
S5917	058	0		29	10	S5917_058_0	1	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010001000000	30	90								30				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00				90.00									4
S5917	058	0		29	10	S5917_058_0	1	3	1	Non-Preferred Generic	000100	1	2	Non-Preferred Generic	010000000010000000000	30									30												Non-Preferred Generic	2	2		010000000010000000000	Non-Preferred Generic																						Non-Preferred Generic	60.00									60.00													4
S5917	058	0		29	10	S5917_058_0	1	4	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	010000000010000000000	30									30												Non-Preferred Brand	2	2		010000000010000000000	Non-Preferred Brand																						Non-Preferred Brand	60.00									60.00													4
S5917	058	0		29	10	S5917_058_0	1	5	1	Specialty Drugs	010010	1	1	Specialty Drugs	011000000010001000000	30	90								30				90								Specialty Drugs	2	1	011000000010001000000		Specialty Drugs	30	30								30				30								Specialty Drugs																							4
S5921	001	0		29	10	S5921_001_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	001	0		29	10	S5921_001_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	001	0		29	10	S5921_001_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	001	0		29	10	S5921_001_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.95	140.85								46.95							125.85			140.85			2
S5921	002	0		29	10	S5921_002_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	002	0		29	10	S5921_002_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.85	137.55								45.85							122.55			137.55			3
S5921	002	0		29	10	S5921_002_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	002	0		29	10	S5921_002_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	003	0		29	10	S5921_003_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	003	0		29	10	S5921_003_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	003	0		29	10	S5921_003_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	003	0		29	10	S5921_003_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	003	0		29	10	S5921_003_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	003	0		29	10	S5921_003_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.70	206.10								68.70							191.10			206.10			4
S5921	003	0		29	10	S5921_003_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	003	0		29	10	S5921_003_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	011	0		29	10	S5921_011_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	011	0		29	10	S5921_011_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.40	139.20								46.40							124.20			139.20			2
S5921	011	0		29	10	S5921_011_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	011	0		29	10	S5921_011_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	012	0		29	10	S5921_012_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	012	0		29	10	S5921_012_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	012	0		29	10	S5921_012_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	012	0		29	10	S5921_012_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.55	136.65								45.55							121.65			136.65			3
S5921	013	0		29	10	S5921_013_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	013	0		29	10	S5921_013_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	013	0		29	10	S5921_013_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	013	0		29	10	S5921_013_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	013	0		29	10	S5921_013_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	013	0		29	10	S5921_013_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	69.90	209.70								69.90							194.70			209.70			4
S5921	013	0		29	10	S5921_013_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	013	0		29	10	S5921_013_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	021	0		29	10	S5921_021_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.65	136.95								45.65							121.95			136.95			2
S5921	021	0		29	10	S5921_021_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	021	0		29	10	S5921_021_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	021	0		29	10	S5921_021_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	022	0		29	10	S5921_022_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	022	0		29	10	S5921_022_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.65	136.95								45.65							121.95			136.95			3
S5921	022	0		29	10	S5921_022_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	022	0		29	10	S5921_022_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	023	0		29	10	S5921_023_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	023	0		29	10	S5921_023_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	023	0		29	10	S5921_023_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	023	0		29	10	S5921_023_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	023	0		29	10	S5921_023_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	023	0		29	10	S5921_023_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.10	204.30								68.10							189.30			204.30			4
S5921	023	0		29	10	S5921_023_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	023	0		29	10	S5921_023_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	031	0		29	10	S5921_031_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	031	0		29	10	S5921_031_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	031	0		29	10	S5921_031_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.40	139.20								46.40							124.20			139.20			2
S5921	031	0		29	10	S5921_031_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	032	0		29	10	S5921_032_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	032	0		29	10	S5921_032_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	032	0		29	10	S5921_032_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	43.90	131.70								43.90							116.70			131.70			3
S5921	032	0		29	10	S5921_032_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	033	0		29	10	S5921_033_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	61.95	185.85								61.95							170.85			185.85			4
S5921	033	0		29	10	S5921_033_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	033	0		29	10	S5921_033_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	033	0		29	10	S5921_033_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	033	0		29	10	S5921_033_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	033	0		29	10	S5921_033_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	033	0		29	10	S5921_033_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	033	0		29	10	S5921_033_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	041	0		29	10	S5921_041_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	041	0		29	10	S5921_041_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	47.30	141.90								47.30							126.90			141.90			2
S5921	041	0		29	10	S5921_041_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	041	0		29	10	S5921_041_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	042	0		29	10	S5921_042_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	49.30	147.90								49.30							132.90			147.90			3
S5921	042	0		29	10	S5921_042_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	042	0		29	10	S5921_042_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	042	0		29	10	S5921_042_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	043	0		29	10	S5921_043_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	043	0		29	10	S5921_043_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	043	0		29	10	S5921_043_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	043	0		29	10	S5921_043_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	043	0		29	10	S5921_043_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	043	0		29	10	S5921_043_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	043	0		29	10	S5921_043_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	043	0		29	10	S5921_043_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	72.35	217.05								72.35							202.05			217.05			4
S5921	051	0		29	10	S5921_051_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	051	0		29	10	S5921_051_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	051	0		29	10	S5921_051_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.15	138.45								46.15							123.45			138.45			2
S5921	051	0		29	10	S5921_051_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	052	0		29	10	S5921_052_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	43.60	130.80								43.60							115.80			130.80			3
S5921	052	0		29	10	S5921_052_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	052	0		29	10	S5921_052_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	052	0		29	10	S5921_052_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	053	0		29	10	S5921_053_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	053	0		29	10	S5921_053_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	053	0		29	10	S5921_053_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.20	186.60								62.20							171.60			186.60			4
S5921	053	0		29	10	S5921_053_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	053	0		29	10	S5921_053_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	053	0		29	10	S5921_053_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	053	0		29	10	S5921_053_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	053	0		29	10	S5921_053_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	061	0		29	10	S5921_061_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.45	136.35								45.45							121.35			136.35			2
S5921	061	0		29	10	S5921_061_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	061	0		29	10	S5921_061_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	061	0		29	10	S5921_061_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	062	0		29	10	S5921_062_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	062	0		29	10	S5921_062_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	062	0		29	10	S5921_062_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	42.75	128.25								42.75							113.25			128.25			3
S5921	062	0		29	10	S5921_062_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	063	0		29	10	S5921_063_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	063	0		29	10	S5921_063_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	063	0		29	10	S5921_063_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	063	0		29	10	S5921_063_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	063	0		29	10	S5921_063_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	60.00	180.00								60.00							165.00			180.00			4
S5921	063	0		29	10	S5921_063_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	063	0		29	10	S5921_063_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	063	0		29	10	S5921_063_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	071	0		29	10	S5921_071_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	071	0		29	10	S5921_071_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	071	0		29	10	S5921_071_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	071	0		29	10	S5921_071_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.30	138.90								46.30							123.90			138.90			2
S5921	072	0		29	10	S5921_072_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	072	0		29	10	S5921_072_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.80	134.40								44.80							119.40			134.40			3
S5921	072	0		29	10	S5921_072_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	072	0		29	10	S5921_072_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	073	0		29	10	S5921_073_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	073	0		29	10	S5921_073_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	073	0		29	10	S5921_073_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	073	0		29	10	S5921_073_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	66.85	200.55								66.85							185.55			200.55			4
S5921	073	0		29	10	S5921_073_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	073	0		29	10	S5921_073_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	073	0		29	10	S5921_073_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	073	0		29	10	S5921_073_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	081	0		29	10	S5921_081_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	081	0		29	10	S5921_081_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	081	0		29	10	S5921_081_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.85	137.55								45.85							122.55			137.55			2
S5921	081	0		29	10	S5921_081_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	082	0		29	10	S5921_082_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	082	0		29	10	S5921_082_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	47.70	143.10								47.70							128.10			143.10			3
S5921	082	0		29	10	S5921_082_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	082	0		29	10	S5921_082_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	083	0		29	10	S5921_083_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	69.25	207.75								69.25							192.75			207.75			4
S5921	083	0		29	10	S5921_083_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	083	0		29	10	S5921_083_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	083	0		29	10	S5921_083_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	083	0		29	10	S5921_083_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	083	0		29	10	S5921_083_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	083	0		29	10	S5921_083_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	083	0		29	10	S5921_083_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	091	0		29	10	S5921_091_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.20	135.60								45.20							120.60			135.60			2
S5921	091	0		29	10	S5921_091_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	091	0		29	10	S5921_091_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	091	0		29	10	S5921_091_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	092	0		29	10	S5921_092_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.15	132.45								44.15							117.45			132.45			3
S5921	092	0		29	10	S5921_092_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	092	0		29	10	S5921_092_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	092	0		29	10	S5921_092_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	093	0		29	10	S5921_093_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	093	0		29	10	S5921_093_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	093	0		29	10	S5921_093_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	64.95	194.85								64.95							179.85			194.85			4
S5921	093	0		29	10	S5921_093_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	093	0		29	10	S5921_093_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	093	0		29	10	S5921_093_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	093	0		29	10	S5921_093_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	093	0		29	10	S5921_093_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	101	0		29	10	S5921_101_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.05	138.15								46.05							123.15			138.15			2
S5921	101	0		29	10	S5921_101_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	101	0		29	10	S5921_101_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	101	0		29	10	S5921_101_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	102	0		29	10	S5921_102_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.65	136.95								45.65							121.95			136.95			3
S5921	102	0		29	10	S5921_102_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	102	0		29	10	S5921_102_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	102	0		29	10	S5921_102_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	103	0		29	10	S5921_103_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	103	0		29	10	S5921_103_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	103	0		29	10	S5921_103_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.85	203.55								67.85							188.55			203.55			4
S5921	103	0		29	10	S5921_103_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	103	0		29	10	S5921_103_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	103	0		29	10	S5921_103_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	103	0		29	10	S5921_103_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	103	0		29	10	S5921_103_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	111	0		29	10	S5921_111_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	111	0		29	10	S5921_111_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	111	0		29	10	S5921_111_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.80	137.40								45.80							122.40			137.40			2
S5921	111	0		29	10	S5921_111_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	112	0		29	10	S5921_112_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	112	0		29	10	S5921_112_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.45	133.35								44.45							118.35			133.35			3
S5921	112	0		29	10	S5921_112_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	112	0		29	10	S5921_112_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	113	0		29	10	S5921_113_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	113	0		29	10	S5921_113_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	113	0		29	10	S5921_113_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	113	0		29	10	S5921_113_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	113	0		29	10	S5921_113_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.05	186.15								62.05							171.15			186.15			4
S5921	113	0		29	10	S5921_113_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	113	0		29	10	S5921_113_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	113	0		29	10	S5921_113_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	121	0		29	10	S5921_121_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.45	139.35								46.45							124.35			139.35			2
S5921	121	0		29	10	S5921_121_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	121	0		29	10	S5921_121_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	121	0		29	10	S5921_121_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	122	0		29	10	S5921_122_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.50	136.50								45.50							121.50			136.50			3
S5921	122	0		29	10	S5921_122_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	122	0		29	10	S5921_122_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	122	0		29	10	S5921_122_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	123	0		29	10	S5921_123_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	123	0		29	10	S5921_123_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	123	0		29	10	S5921_123_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	66.05	198.15								66.05							183.15			198.15			4
S5921	123	0		29	10	S5921_123_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	123	0		29	10	S5921_123_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	123	0		29	10	S5921_123_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	123	0		29	10	S5921_123_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	123	0		29	10	S5921_123_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	131	0		29	10	S5921_131_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.70	137.10								45.70							122.10			137.10			2
S5921	131	0		29	10	S5921_131_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	131	0		29	10	S5921_131_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	131	0		29	10	S5921_131_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	132	0		29	10	S5921_132_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.05	132.15								44.05							117.15			132.15			3
S5921	132	0		29	10	S5921_132_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	132	0		29	10	S5921_132_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	132	0		29	10	S5921_132_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	133	0		29	10	S5921_133_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	133	0		29	10	S5921_133_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	133	0		29	10	S5921_133_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	63.40	190.20								63.40							175.20			190.20			4
S5921	133	0		29	10	S5921_133_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	133	0		29	10	S5921_133_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	133	0		29	10	S5921_133_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	133	0		29	10	S5921_133_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	133	0		29	10	S5921_133_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	141	0		29	10	S5921_141_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.15	138.45								46.15							123.45			138.45			2
S5921	141	0		29	10	S5921_141_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	141	0		29	10	S5921_141_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	141	0		29	10	S5921_141_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	142	0		29	10	S5921_142_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.35	133.05								44.35							118.05			133.05			3
S5921	142	0		29	10	S5921_142_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	142	0		29	10	S5921_142_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	142	0		29	10	S5921_142_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	143	0		29	10	S5921_143_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	143	0		29	10	S5921_143_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	143	0		29	10	S5921_143_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.85	197.55								65.85							182.55			197.55			4
S5921	143	0		29	10	S5921_143_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	143	0		29	10	S5921_143_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	143	0		29	10	S5921_143_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	143	0		29	10	S5921_143_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	143	0		29	10	S5921_143_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	151	0		29	10	S5921_151_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	151	0		29	10	S5921_151_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	151	0		29	10	S5921_151_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.10	138.30								46.10							123.30			138.30			2
S5921	151	0		29	10	S5921_151_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	152	0		29	10	S5921_152_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	43.05	129.15								43.05							114.15			129.15			3
S5921	152	0		29	10	S5921_152_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	152	0		29	10	S5921_152_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	152	0		29	10	S5921_152_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	153	0		29	10	S5921_153_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	153	0		29	10	S5921_153_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	153	0		29	10	S5921_153_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	153	0		29	10	S5921_153_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	153	0		29	10	S5921_153_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	61.85	185.55								61.85							170.55			185.55			4
S5921	153	0		29	10	S5921_153_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	153	0		29	10	S5921_153_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	153	0		29	10	S5921_153_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	161	0		29	10	S5921_161_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.10	138.30								46.10							123.30			138.30			2
S5921	161	0		29	10	S5921_161_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	161	0		29	10	S5921_161_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	161	0		29	10	S5921_161_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	162	0		29	10	S5921_162_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.75	134.25								44.75							119.25			134.25			3
S5921	162	0		29	10	S5921_162_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	162	0		29	10	S5921_162_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	162	0		29	10	S5921_162_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	163	0		29	10	S5921_163_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	163	0		29	10	S5921_163_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	163	0		29	10	S5921_163_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.70	188.10								62.70							173.10			188.10			4
S5921	163	0		29	10	S5921_163_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	163	0		29	10	S5921_163_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	163	0		29	10	S5921_163_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	163	0		29	10	S5921_163_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	163	0		29	10	S5921_163_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	171	0		29	10	S5921_171_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.65	136.95								45.65							121.95			136.95			2
S5921	171	0		29	10	S5921_171_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	171	0		29	10	S5921_171_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	171	0		29	10	S5921_171_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	172	0		29	10	S5921_172_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.95	137.85								45.95							122.85			137.85			3
S5921	172	0		29	10	S5921_172_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	172	0		29	10	S5921_172_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	172	0		29	10	S5921_172_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	173	0		29	10	S5921_173_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	173	0		29	10	S5921_173_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	173	0		29	10	S5921_173_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.35	205.05								68.35							190.05			205.05			4
S5921	173	0		29	10	S5921_173_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	173	0		29	10	S5921_173_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	173	0		29	10	S5921_173_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	173	0		29	10	S5921_173_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	173	0		29	10	S5921_173_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	181	0		29	10	S5921_181_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.30	138.90								46.30							123.90			138.90			2
S5921	181	0		29	10	S5921_181_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	181	0		29	10	S5921_181_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	181	0		29	10	S5921_181_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	182	0		29	10	S5921_182_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.65	136.95								45.65							121.95			136.95			3
S5921	182	0		29	10	S5921_182_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	182	0		29	10	S5921_182_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	182	0		29	10	S5921_182_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	183	0		29	10	S5921_183_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	183	0		29	10	S5921_183_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	183	0		29	10	S5921_183_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.50	205.50								68.50							190.50			205.50			4
S5921	183	0		29	10	S5921_183_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	183	0		29	10	S5921_183_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	183	0		29	10	S5921_183_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	183	0		29	10	S5921_183_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	183	0		29	10	S5921_183_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	191	0		29	10	S5921_191_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	191	0		29	10	S5921_191_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	191	0		29	10	S5921_191_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.95	137.85								45.95							122.85			137.85			2
S5921	191	0		29	10	S5921_191_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	192	0		29	10	S5921_192_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	192	0		29	10	S5921_192_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.65	133.95								44.65							118.95			133.95			3
S5921	192	0		29	10	S5921_192_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	192	0		29	10	S5921_192_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	193	0		29	10	S5921_193_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	193	0		29	10	S5921_193_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	193	0		29	10	S5921_193_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	193	0		29	10	S5921_193_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	193	0		29	10	S5921_193_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.35	196.05								65.35							181.05			196.05			4
S5921	193	0		29	10	S5921_193_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	193	0		29	10	S5921_193_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	193	0		29	10	S5921_193_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	201	0		29	10	S5921_201_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.60	139.80								46.60							124.80			139.80			2
S5921	201	0		29	10	S5921_201_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	201	0		29	10	S5921_201_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	201	0		29	10	S5921_201_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	202	0		29	10	S5921_202_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	202	0		29	10	S5921_202_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.55	133.65								44.55							118.65			133.65			3
S5921	202	0		29	10	S5921_202_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	202	0		29	10	S5921_202_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	203	0		29	10	S5921_203_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	203	0		29	10	S5921_203_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.80	140.40								46.80							125.40			140.40			2
S5921	203	0		29	10	S5921_203_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	203	0		29	10	S5921_203_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	207	0		29	10	S5921_207_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	43.95	131.85								43.95							116.85			131.85			3
S5921	207	0		29	10	S5921_207_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	207	0		29	10	S5921_207_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	207	0		29	10	S5921_207_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	213	0		29	10	S5921_213_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	213	0		29	10	S5921_213_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	213	0		29	10	S5921_213_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	64.85	194.55								64.85							179.55			194.55			4
S5921	213	0		29	10	S5921_213_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	213	0		29	10	S5921_213_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	213	0		29	10	S5921_213_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	213	0		29	10	S5921_213_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	213	0		29	10	S5921_213_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	221	0		29	10	S5921_221_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.80	137.40								45.80							122.40			137.40			2
S5921	221	0		29	10	S5921_221_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	221	0		29	10	S5921_221_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	221	0		29	10	S5921_221_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	222	0		29	10	S5921_222_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.70	137.10								45.70							122.10			137.10			3
S5921	222	0		29	10	S5921_222_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	222	0		29	10	S5921_222_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	222	0		29	10	S5921_222_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	223	0		29	10	S5921_223_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	223	0		29	10	S5921_223_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	223	0		29	10	S5921_223_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	68.20	204.60								68.20							189.60			204.60			4
S5921	223	0		29	10	S5921_223_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	223	0		29	10	S5921_223_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	223	0		29	10	S5921_223_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	223	0		29	10	S5921_223_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	223	0		29	10	S5921_223_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	231	0		29	10	S5921_231_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	231	0		29	10	S5921_231_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	231	0		29	10	S5921_231_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.40	133.20								44.40							118.20			133.20			2
S5921	231	0		29	10	S5921_231_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	232	0		29	10	S5921_232_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	232	0		29	10	S5921_232_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.30	135.90								45.30							120.90			135.90			3
S5921	232	0		29	10	S5921_232_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	232	0		29	10	S5921_232_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	233	0		29	10	S5921_233_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	233	0		29	10	S5921_233_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	233	0		29	10	S5921_233_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	66.55	199.65								66.55							184.65			199.65			4
S5921	233	0		29	10	S5921_233_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	233	0		29	10	S5921_233_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	233	0		29	10	S5921_233_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	233	0		29	10	S5921_233_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	233	0		29	10	S5921_233_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	235	0		29	10	S5921_235_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	235	0		29	10	S5921_235_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.95	188.85								62.95							173.85			188.85			4
S5921	235	0		29	10	S5921_235_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	235	0		29	10	S5921_235_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	235	0		29	10	S5921_235_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	235	0		29	10	S5921_235_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	235	0		29	10	S5921_235_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	235	0		29	10	S5921_235_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	237	0		29	10	S5921_237_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.05	138.15								46.05							123.15			138.15			2
S5921	237	0		29	10	S5921_237_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	237	0		29	10	S5921_237_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	237	0		29	10	S5921_237_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	238	0		29	10	S5921_238_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.75	137.25								45.75							122.25			137.25			3
S5921	238	0		29	10	S5921_238_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	238	0		29	10	S5921_238_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	238	0		29	10	S5921_238_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	239	0		29	10	S5921_239_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	239	0		29	10	S5921_239_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	239	0		29	10	S5921_239_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	69.10	207.30								69.10							192.30			207.30			4
S5921	239	0		29	10	S5921_239_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	239	0		29	10	S5921_239_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	239	0		29	10	S5921_239_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	239	0		29	10	S5921_239_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	239	0		29	10	S5921_239_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	247	0		29	10	S5921_247_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.25	138.75								46.25							123.75			138.75			2
S5921	247	0		29	10	S5921_247_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	247	0		29	10	S5921_247_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	247	0		29	10	S5921_247_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	248	0		29	10	S5921_248_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.10	135.30								45.10							120.30			135.30			3
S5921	248	0		29	10	S5921_248_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	248	0		29	10	S5921_248_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	248	0		29	10	S5921_248_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	249	0		29	10	S5921_249_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	249	0		29	10	S5921_249_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	249	0		29	10	S5921_249_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	65.05	195.15								65.05							180.15			195.15			4
S5921	249	0		29	10	S5921_249_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	249	0		29	10	S5921_249_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	249	0		29	10	S5921_249_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	249	0		29	10	S5921_249_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	249	0		29	10	S5921_249_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	261	0		29	10	S5921_261_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	261	0		29	10	S5921_261_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	261	0		29	10	S5921_261_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.05	138.15								46.05							123.15			138.15			2
S5921	261	0		29	10	S5921_261_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	262	0		29	10	S5921_262_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	262	0		29	10	S5921_262_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	47.95	143.85								47.95							128.85			143.85			3
S5921	262	0		29	10	S5921_262_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	262	0		29	10	S5921_262_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	263	0		29	10	S5921_263_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	263	0		29	10	S5921_263_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	263	0		29	10	S5921_263_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	263	0		29	10	S5921_263_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	263	0		29	10	S5921_263_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	263	0		29	10	S5921_263_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	71.35	214.05								71.35							199.05			214.05			4
S5921	263	0		29	10	S5921_263_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	263	0		29	10	S5921_263_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	265	0		29	10	S5921_265_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	265	0		29	10	S5921_265_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.80	134.40								44.80							119.40			134.40			2
S5921	265	0		29	10	S5921_265_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	265	0		29	10	S5921_265_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	266	0		29	10	S5921_266_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	266	0		29	10	S5921_266_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	266	0		29	10	S5921_266_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.85	140.55								46.85							125.55			140.55			3
S5921	266	0		29	10	S5921_266_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	273	0		29	10	S5921_273_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	273	0		29	10	S5921_273_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	273	0		29	10	S5921_273_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	70.60	211.80								70.60							196.80			211.80			4
S5921	273	0		29	10	S5921_273_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	273	0		29	10	S5921_273_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	273	0		29	10	S5921_273_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	273	0		29	10	S5921_273_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	273	0		29	10	S5921_273_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	281	0		29	10	S5921_281_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	281	0		29	10	S5921_281_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.25	138.75								46.25							123.75			138.75			2
S5921	281	0		29	10	S5921_281_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	281	0		29	10	S5921_281_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	282	0		29	10	S5921_282_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.25	132.75								44.25							117.75			132.75			3
S5921	282	0		29	10	S5921_282_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	282	0		29	10	S5921_282_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	282	0		29	10	S5921_282_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	283	0		29	10	S5921_283_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	283	0		29	10	S5921_283_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	283	0		29	10	S5921_283_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	283	0		29	10	S5921_283_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	283	0		29	10	S5921_283_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.95	188.85								62.95							173.85			188.85			4
S5921	283	0		29	10	S5921_283_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	283	0		29	10	S5921_283_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	283	0		29	10	S5921_283_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	286	0		29	10	S5921_286_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.45	136.35								45.45							121.35			136.35			2
S5921	286	0		29	10	S5921_286_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	286	0		29	10	S5921_286_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	286	0		29	10	S5921_286_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	288	0		29	10	S5921_288_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	45.70	137.10								45.70							122.10			137.10			3
S5921	288	0		29	10	S5921_288_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	288	0		29	10	S5921_288_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	288	0		29	10	S5921_288_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	293	0		29	10	S5921_293_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	293	0		29	10	S5921_293_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	293	0		29	10	S5921_293_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	67.25	201.75								67.25							186.75			201.75			4
S5921	293	0		29	10	S5921_293_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	293	0		29	10	S5921_293_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	293	0		29	10	S5921_293_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	293	0		29	10	S5921_293_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	293	0		29	10	S5921_293_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	301	0		29	10	S5921_301_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	301	0		29	10	S5921_301_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.30	138.90								46.30							123.90			138.90			2
S5921	301	0		29	10	S5921_301_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	301	0		29	10	S5921_301_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	302	0		29	10	S5921_302_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	302	0		29	10	S5921_302_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	302	0		29	10	S5921_302_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	43.60	130.80								43.60							115.80			130.80			3
S5921	302	0		29	10	S5921_302_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	303	0		29	10	S5921_303_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	61.30	183.90								61.30							168.90			183.90			4
S5921	303	0		29	10	S5921_303_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	303	0		29	10	S5921_303_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	303	0		29	10	S5921_303_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	303	0		29	10	S5921_303_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	303	0		29	10	S5921_303_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	303	0		29	10	S5921_303_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	303	0		29	10	S5921_303_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	311	0		29	10	S5921_311_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	311	0		29	10	S5921_311_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	311	0		29	10	S5921_311_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.65	139.95								46.65							124.95			139.95			2
S5921	311	0		29	10	S5921_311_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	312	0		29	10	S5921_312_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	44.00	132.00								44.00							117.00			132.00			3
S5921	312	0		29	10	S5921_312_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	312	0		29	10	S5921_312_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	312	0		29	10	S5921_312_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	313	0		29	10	S5921_313_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	313	0		29	10	S5921_313_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	313	0		29	10	S5921_313_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	313	0		29	10	S5921_313_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	313	0		29	10	S5921_313_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	63.10	189.30								63.10							174.30			189.30			4
S5921	313	0		29	10	S5921_313_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	313	0		29	10	S5921_313_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	313	0		29	10	S5921_313_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	321	0		29	10	S5921_321_0	4	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	321	0		29	10	S5921_321_0	4	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	46.65	139.95								46.65							124.95			139.95			2
S5921	321	0		29	10	S5921_321_0	4	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	321	0		29	10	S5921_321_0	4	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	322	0		29	10	S5921_322_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	43.65	130.95								43.65							115.95			130.95			3
S5921	322	0		29	10	S5921_322_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	322	0		29	10	S5921_322_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	322	0		29	10	S5921_322_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	323	0		29	10	S5921_323_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	323	0		29	10	S5921_323_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	323	0		29	10	S5921_323_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	323	0		29	10	S5921_323_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	323	0		29	10	S5921_323_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	62.45	187.35								62.45							172.35			187.35			4
S5921	323	0		29	10	S5921_323_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	323	0		29	10	S5921_323_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	323	0		29	10	S5921_323_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5921	331	0		29	10	S5921_331_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	47.05	141.15								47.05							126.15			141.15			2
S5921	331	0		29	10	S5921_331_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			2
S5921	331	0		29	10	S5921_331_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	5.00	15.00								5.00							5.00			15.00			2
S5921	331	0		29	10	S5921_331_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	25	25								25							25			25		Tier 4 Specialty																							2
S5921	332	0		29	10	S5921_332_0	3	3	1	Tier 3 Non Preferred	000010		2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	43.80	131.40								43.80							116.40			131.40			3
S5921	332	0		29	10	S5921_332_0	3	2	1	Tier 2	000001		2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	20.00	60.00								20.00							45.00			60.00			3
S5921	332	0		29	10	S5921_332_0	3	1	1	Tier 1	010000		2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	7.00	21.00								7.00							7.00			21.00			3
S5921	332	0		29	10	S5921_332_0	3	4	1	Tier 4 Specialty	000010		1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							3
S5921	333	0		29	10	S5921_333_0	2	1	1	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00			4
S5921	333	0		29	10	S5921_333_0	2	2	1	Tier 2	000001	3	2	Tier 2	011000000010000001001	31	90								31							90			90		Tier 2	2	2		011000000010000001001	Tier 2																						Tier 2	28.00	84.00								28.00							69.00			84.00			4
S5921	333	0		29	10	S5921_333_0	2	3	1	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred	011000000010000001001	31	90								31							90			90		Tier 3 Non Preferred	2	2		011000000010000001001	Tier 3 Non Preferred																						Tier 3 Non Preferred	64.00	192.00								64.00							177.00			192.00			4
S5921	333	0		29	10	S5921_333_0	2	4	1	Tier 4 Specialty	000010	1	1	Tier 4 Specialty	011000000010000001001	31	90								31							90			90		Tier 4 Specialty	2	1	011000000010000001001		Tier 4 Specialty	33	33								33							33			33		Tier 4 Specialty																							4
S5921	333	0		29	10	S5921_333_0	2	1	3	Tier 1	010000	3	2	Tier 1	011000000010000001001	31	90								31							90			90		Tier 1	2	2		011000000010000001001	Tier 1																						Tier 1	6.00	18.00								6.00							6.00			18.00		1	4
S5921	333	0		29	10	S5921_333_0	2	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5921	333	0		29	10	S5921_333_0	2	3	3	Tier 3 Non Preferred	000010	1	2	Tier 3 Non Preferred																							Tier 3 Non Preferred					Tier 3 Non Preferred																						Tier 3 Non Preferred																						2	4
S5921	333	0		29	10	S5921_333_0	2	4	3	Tier 4 Specialty	000010	1	1	Tier 4 Specialty																							Tier 4 Specialty					Tier 4 Specialty																						Tier 4 Specialty																						2	4
S5937	001	0		29	10	S5937_001_0	1	1	1	Value Generic	010000		2	Value Generic	011000000011011000000	34	90								34	90		34	90								Value Generic	2	2		011000000011011000000	Value Generic																						Value Generic	0.00	0.00								0.00	0.00		0.00	0.00									3
S5937	001	0		29	10	S5937_001_0	1	2	1	Generic	010000		2	Generic	011000000011011000000	34	90								34	90		34	90								Generic	2	2		011000000011011000000	Generic																						Generic	4.00	12.00								4.00	12.00		4.00	12.00									3
S5937	001	0		29	10	S5937_001_0	1	5	1	Specialty	010010		1	Specialty	011000000011011000000	34	90								34	90		34	90								Specialty	2	1	011000000011011000000		Specialty	33	33								33	33		33	33								Specialty																							3
S5937	001	0		29	10	S5937_001_0	1	4	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011011000000	34	90								34	90		34	90								Non-Preferred Brand	2	2		011000000011011000000	Non-Preferred Brand																						Non-Preferred Brand	55.00	165.00								55.00	165.00		55.00	165.00									3
S5937	001	0		29	10	S5937_001_0	1	3	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	34	90								34	90		34	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00		20.00	60.00									3
S5946	003	0		29	10	S5946_003_0	4	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									3
S5946	003	0		29	10	S5946_003_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	24.00	60.00								24.00				48.00									3
S5946	003	0		29	10	S5946_003_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	48.00	120.00								48.00				96.00									3
S5946	003	0		29	10	S5946_003_0	4	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
S5946	004	0		29	10	S5946_004_0	4	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	10.00	25.00								10.00				20.00									3
S5946	004	0		29	10	S5946_004_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	24.00	60.00								24.00				48.00									3
S5946	004	0		29	10	S5946_004_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	48.00	120.00								48.00				96.00									3
S5946	004	0		29	10	S5946_004_0	4	4	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
S5953	001	0		29	10	S5953_001_0	3	2	1	Brand	000010		2	Brand	011000000010001000000	34	90								34				90								Brand	2	2		011000000010001000000	Brand																						Brand	29.00	58.00								43.50				58.00									3
S5953	001	0		29	10	S5953_001_0	3	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	12.00								9.00				12.00									3
S5953	001	0		29	10	S5953_001_0	3	3	1	Specialty	000010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
S5953	002	0		29	10	S5953_002_0	3	1	1	Generic	010000		2	Generic	011000000010001000000	34	90								34				90								Generic	2	2		011000000010001000000	Generic																						Generic	6.00	12.00								9.00				12.00									3
S5953	002	0		29	10	S5953_002_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	34	90								34				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	26.00	52.00								39.00				52.00									3
S5953	002	0		29	10	S5953_002_0	3	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	34	90								34				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	56.00	112.00								84.00				112.00									3
S5953	002	0		29	10	S5953_002_0	3	4	1	Specialty	010010		1	Specialty	011000000010001000000	34	90								34				90								Specialty	2	1	011000000010001000000		Specialty	33	33								33				33								Specialty																							3
S5954	004	0		29	10	S5954_004_0	6	2	1	Tier 2	001001		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	15.00	30.00								30.00				30.00									3
S5954	004	0		29	10	S5954_004_0	6	1	1	Tier 1	001001		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	10.00								10.00				10.00									3
S5954	004	0		29	10	S5954_004_0	6	3	1	Tier 3	100100		2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	35.00	70.00								70.00				70.00									3
S5954	004	0		29	10	S5954_004_0	6	4	1	Tier 4	000010		1	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							3
S5954	005	0		29	10	S5954_005_0	5	1	1	Tier 1	001001	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	10.00								10.00				10.00									4
S5954	005	0		29	10	S5954_005_0	5	2	1	Tier 2	001001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	25.00	50.00								50.00				50.00									4
S5954	005	0		29	10	S5954_005_0	5	3	1	Tier 3	100100	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	60.00	120.00								90.00				120.00									4
S5954	005	0		29	10	S5954_005_0	5	4	1	Tier 4	000010	1	1	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							4
S5954	005	0		29	10	S5954_005_0	5	1	3	Tier 1	001001	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	10.00								10.00				10.00								1	4
S5954	005	0		29	10	S5954_005_0	5	2	3	Tier 2	001001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5954	005	0		29	10	S5954_005_0	5	3	3	Tier 3	100100	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5954	005	0		29	10	S5954_005_0	5	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5960	001	0		29	10	S5960_001_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	001	0		29	10	S5960_001_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	001	0		29	10	S5960_001_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	001	0		29	10	S5960_001_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	002	0		29	10	S5960_002_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	002	0		29	10	S5960_002_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	002	0		29	10	S5960_002_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	002	0		29	10	S5960_002_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	003	0		29	10	S5960_003_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	003	0		29	10	S5960_003_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	003	0		29	10	S5960_003_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	003	0		29	10	S5960_003_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	004	0		29	10	S5960_004_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	004	0		29	10	S5960_004_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	004	0		29	10	S5960_004_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	004	0		29	10	S5960_004_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	005	0		29	10	S5960_005_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	005	0		29	10	S5960_005_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	005	0		29	10	S5960_005_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	005	0		29	10	S5960_005_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	006	0		29	10	S5960_006_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	006	0		29	10	S5960_006_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	006	0		29	10	S5960_006_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	006	0		29	10	S5960_006_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	007	0		29	10	S5960_007_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	007	0		29	10	S5960_007_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	007	0		29	10	S5960_007_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	007	0		29	10	S5960_007_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	008	0		29	10	S5960_008_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	008	0		29	10	S5960_008_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	008	0		29	10	S5960_008_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	008	0		29	10	S5960_008_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	009	0		29	10	S5960_009_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	009	0		29	10	S5960_009_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	009	0		29	10	S5960_009_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	009	0		29	10	S5960_009_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	010	0		29	10	S5960_010_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	010	0		29	10	S5960_010_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	010	0		29	10	S5960_010_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	010	0		29	10	S5960_010_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	011	0		29	10	S5960_011_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	011	0		29	10	S5960_011_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	011	0		29	10	S5960_011_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	011	0		29	10	S5960_011_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	012	0		29	10	S5960_012_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	012	0		29	10	S5960_012_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	012	0		29	10	S5960_012_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	012	0		29	10	S5960_012_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	013	0		29	10	S5960_013_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	013	0		29	10	S5960_013_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	013	0		29	10	S5960_013_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	013	0		29	10	S5960_013_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	014	0		29	10	S5960_014_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	014	0		29	10	S5960_014_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	014	0		29	10	S5960_014_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	014	0		29	10	S5960_014_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	015	0		29	10	S5960_015_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	015	0		29	10	S5960_015_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	015	0		29	10	S5960_015_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	015	0		29	10	S5960_015_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	016	0		29	10	S5960_016_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	016	0		29	10	S5960_016_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	016	0		29	10	S5960_016_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	016	0		29	10	S5960_016_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	017	0		29	10	S5960_017_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	017	0		29	10	S5960_017_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	017	0		29	10	S5960_017_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	017	0		29	10	S5960_017_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	018	0		29	10	S5960_018_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	018	0		29	10	S5960_018_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	018	0		29	10	S5960_018_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	018	0		29	10	S5960_018_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	019	0		29	10	S5960_019_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	019	0		29	10	S5960_019_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	019	0		29	10	S5960_019_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	019	0		29	10	S5960_019_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	020	0		29	10	S5960_020_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	020	0		29	10	S5960_020_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	020	0		29	10	S5960_020_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	020	0		29	10	S5960_020_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	021	0		29	10	S5960_021_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	021	0		29	10	S5960_021_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	021	0		29	10	S5960_021_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	021	0		29	10	S5960_021_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	022	0		29	10	S5960_022_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	022	0		29	10	S5960_022_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	022	0		29	10	S5960_022_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	022	0		29	10	S5960_022_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	023	0		29	10	S5960_023_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	023	0		29	10	S5960_023_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	023	0		29	10	S5960_023_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	023	0		29	10	S5960_023_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	024	0		29	10	S5960_024_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	024	0		29	10	S5960_024_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	024	0		29	10	S5960_024_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	024	0		29	10	S5960_024_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	025	0		29	10	S5960_025_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	025	0		29	10	S5960_025_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	025	0		29	10	S5960_025_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	025	0		29	10	S5960_025_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	026	0		29	10	S5960_026_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	026	0		29	10	S5960_026_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	026	0		29	10	S5960_026_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	026	0		29	10	S5960_026_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	027	0		29	10	S5960_027_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	027	0		29	10	S5960_027_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	027	0		29	10	S5960_027_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	027	0		29	10	S5960_027_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	028	0		29	10	S5960_028_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	028	0		29	10	S5960_028_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	028	0		29	10	S5960_028_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	028	0		29	10	S5960_028_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	029	0		29	10	S5960_029_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	029	0		29	10	S5960_029_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	029	0		29	10	S5960_029_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	029	0		29	10	S5960_029_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	030	0		29	10	S5960_030_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	030	0		29	10	S5960_030_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	030	0		29	10	S5960_030_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	030	0		29	10	S5960_030_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	031	0		29	10	S5960_031_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	031	0		29	10	S5960_031_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	031	0		29	10	S5960_031_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	031	0		29	10	S5960_031_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	032	0		29	10	S5960_032_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	032	0		29	10	S5960_032_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	032	0		29	10	S5960_032_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	032	0		29	10	S5960_032_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	033	0		29	10	S5960_033_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	033	0		29	10	S5960_033_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	033	0		29	10	S5960_033_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	033	0		29	10	S5960_033_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	034	0		29	10	S5960_034_0	3	1	1	Generic	010000		2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	5.00	15.00								5.00							7.50			15.00			2
S5960	034	0		29	10	S5960_034_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	29.00	87.00								29.00							72.50			87.00			2
S5960	034	0		29	10	S5960_034_0	3	4	1	Specialty Injectables	010010		1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	25	25								25							25			25		Specialty Injectables																							2
S5960	034	0		29	10	S5960_034_0	3	3	1	Non-Specialty Injectables	010010		2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	25	25								25							25			25		Non-Specialty Injectables																							2
S5960	039	0		29	10	S5960_039_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	039	0		29	10	S5960_039_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	039	0		29	10	S5960_039_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	039	0		29	10	S5960_039_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	040	0		29	10	S5960_040_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	040	0		29	10	S5960_040_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	040	0		29	10	S5960_040_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	040	0		29	10	S5960_040_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	041	0		29	10	S5960_041_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	041	0		29	10	S5960_041_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	041	0		29	10	S5960_041_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	041	0		29	10	S5960_041_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	042	0		29	10	S5960_042_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	042	0		29	10	S5960_042_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	042	0		29	10	S5960_042_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	042	0		29	10	S5960_042_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	044	0		29	10	S5960_044_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	044	0		29	10	S5960_044_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	044	0		29	10	S5960_044_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	044	0		29	10	S5960_044_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	045	0		29	10	S5960_045_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	045	0		29	10	S5960_045_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	045	0		29	10	S5960_045_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	045	0		29	10	S5960_045_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	047	0		29	10	S5960_047_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	047	0		29	10	S5960_047_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	047	0		29	10	S5960_047_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	047	0		29	10	S5960_047_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	048	0		29	10	S5960_048_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	048	0		29	10	S5960_048_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	048	0		29	10	S5960_048_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	048	0		29	10	S5960_048_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	049	0		29	10	S5960_049_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	049	0		29	10	S5960_049_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	049	0		29	10	S5960_049_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	049	0		29	10	S5960_049_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	053	0		29	10	S5960_053_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	053	0		29	10	S5960_053_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	053	0		29	10	S5960_053_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	053	0		29	10	S5960_053_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	055	0		29	10	S5960_055_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	055	0		29	10	S5960_055_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	055	0		29	10	S5960_055_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	055	0		29	10	S5960_055_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	056	0		29	10	S5960_056_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	056	0		29	10	S5960_056_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	056	0		29	10	S5960_056_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	056	0		29	10	S5960_056_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	057	0		29	10	S5960_057_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	057	0		29	10	S5960_057_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	057	0		29	10	S5960_057_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	057	0		29	10	S5960_057_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	058	0		29	10	S5960_058_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	058	0		29	10	S5960_058_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	058	0		29	10	S5960_058_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	058	0		29	10	S5960_058_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	059	0		29	10	S5960_059_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	059	0		29	10	S5960_059_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	059	0		29	10	S5960_059_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	059	0		29	10	S5960_059_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	061	0		29	10	S5960_061_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	061	0		29	10	S5960_061_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	061	0		29	10	S5960_061_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	061	0		29	10	S5960_061_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	062	0		29	10	S5960_062_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	062	0		29	10	S5960_062_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	062	0		29	10	S5960_062_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	062	0		29	10	S5960_062_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	064	0		29	10	S5960_064_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	064	0		29	10	S5960_064_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	064	0		29	10	S5960_064_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	064	0		29	10	S5960_064_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	066	0		29	10	S5960_066_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	066	0		29	10	S5960_066_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	066	0		29	10	S5960_066_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	066	0		29	10	S5960_066_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	067	0		29	10	S5960_067_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	067	0		29	10	S5960_067_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	067	0		29	10	S5960_067_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	067	0		29	10	S5960_067_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	069	0		29	10	S5960_069_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	069	0		29	10	S5960_069_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	069	0		29	10	S5960_069_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	069	0		29	10	S5960_069_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	070	0		29	10	S5960_070_0	4	3	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	070	0		29	10	S5960_070_0	4	4	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	070	0		29	10	S5960_070_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	070	0		29	10	S5960_070_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	071	0		29	10	S5960_071_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	071	0		29	10	S5960_071_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	071	0		29	10	S5960_071_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	071	0		29	10	S5960_071_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	071	0		29	10	S5960_071_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	071	0		29	10	S5960_071_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	071	0		29	10	S5960_071_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	071	0		29	10	S5960_071_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	071	0		29	10	S5960_071_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	071	0		29	10	S5960_071_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	072	0		29	10	S5960_072_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	072	0		29	10	S5960_072_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	072	0		29	10	S5960_072_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	072	0		29	10	S5960_072_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	072	0		29	10	S5960_072_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	072	0		29	10	S5960_072_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	072	0		29	10	S5960_072_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	072	0		29	10	S5960_072_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	072	0		29	10	S5960_072_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	072	0		29	10	S5960_072_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	073	0		29	10	S5960_073_0	4	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	073	0		29	10	S5960_073_0	4	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	073	0		29	10	S5960_073_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	073	0		29	10	S5960_073_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	073	0		29	10	S5960_073_0	4	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	073	0		29	10	S5960_073_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	073	0		29	10	S5960_073_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	073	0		29	10	S5960_073_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	073	0		29	10	S5960_073_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	073	0		29	10	S5960_073_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	074	0		29	10	S5960_074_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	074	0		29	10	S5960_074_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	074	0		29	10	S5960_074_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	074	0		29	10	S5960_074_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	074	0		29	10	S5960_074_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	074	0		29	10	S5960_074_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	074	0		29	10	S5960_074_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	074	0		29	10	S5960_074_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	074	0		29	10	S5960_074_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	074	0		29	10	S5960_074_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	075	0		29	10	S5960_075_0	4	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	075	0		29	10	S5960_075_0	4	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	075	0		29	10	S5960_075_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	075	0		29	10	S5960_075_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	075	0		29	10	S5960_075_0	4	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	075	0		29	10	S5960_075_0	4	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	075	0		29	10	S5960_075_0	4	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	075	0		29	10	S5960_075_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	075	0		29	10	S5960_075_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	075	0		29	10	S5960_075_0	4	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	076	0		29	10	S5960_076_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	076	0		29	10	S5960_076_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	076	0		29	10	S5960_076_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	076	0		29	10	S5960_076_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	076	0		29	10	S5960_076_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	076	0		29	10	S5960_076_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	076	0		29	10	S5960_076_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	076	0		29	10	S5960_076_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	076	0		29	10	S5960_076_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	076	0		29	10	S5960_076_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	078	0		29	10	S5960_078_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	078	0		29	10	S5960_078_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	078	0		29	10	S5960_078_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	078	0		29	10	S5960_078_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	078	0		29	10	S5960_078_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	078	0		29	10	S5960_078_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	078	0		29	10	S5960_078_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	078	0		29	10	S5960_078_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	078	0		29	10	S5960_078_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	078	0		29	10	S5960_078_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	079	0		29	10	S5960_079_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	079	0		29	10	S5960_079_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	079	0		29	10	S5960_079_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	079	0		29	10	S5960_079_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	079	0		29	10	S5960_079_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	079	0		29	10	S5960_079_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	079	0		29	10	S5960_079_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	079	0		29	10	S5960_079_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	079	0		29	10	S5960_079_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	079	0		29	10	S5960_079_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	080	0		29	10	S5960_080_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	080	0		29	10	S5960_080_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	080	0		29	10	S5960_080_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	080	0		29	10	S5960_080_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	080	0		29	10	S5960_080_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	080	0		29	10	S5960_080_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	080	0		29	10	S5960_080_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	080	0		29	10	S5960_080_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	080	0		29	10	S5960_080_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	080	0		29	10	S5960_080_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	081	0		29	10	S5960_081_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	081	0		29	10	S5960_081_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	081	0		29	10	S5960_081_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	081	0		29	10	S5960_081_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	081	0		29	10	S5960_081_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	081	0		29	10	S5960_081_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	081	0		29	10	S5960_081_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	081	0		29	10	S5960_081_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	081	0		29	10	S5960_081_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	081	0		29	10	S5960_081_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	082	0		29	10	S5960_082_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	082	0		29	10	S5960_082_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	082	0		29	10	S5960_082_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	082	0		29	10	S5960_082_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	082	0		29	10	S5960_082_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	082	0		29	10	S5960_082_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	082	0		29	10	S5960_082_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	082	0		29	10	S5960_082_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	082	0		29	10	S5960_082_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	082	0		29	10	S5960_082_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	083	0		29	10	S5960_083_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	083	0		29	10	S5960_083_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	083	0		29	10	S5960_083_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	083	0		29	10	S5960_083_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	083	0		29	10	S5960_083_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	083	0		29	10	S5960_083_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	083	0		29	10	S5960_083_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	083	0		29	10	S5960_083_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	083	0		29	10	S5960_083_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	083	0		29	10	S5960_083_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	084	0		29	10	S5960_084_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	084	0		29	10	S5960_084_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	084	0		29	10	S5960_084_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	084	0		29	10	S5960_084_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	084	0		29	10	S5960_084_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	084	0		29	10	S5960_084_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	084	0		29	10	S5960_084_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	084	0		29	10	S5960_084_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	084	0		29	10	S5960_084_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	084	0		29	10	S5960_084_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	085	0		29	10	S5960_085_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	085	0		29	10	S5960_085_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	085	0		29	10	S5960_085_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	085	0		29	10	S5960_085_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	085	0		29	10	S5960_085_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	085	0		29	10	S5960_085_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	085	0		29	10	S5960_085_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	085	0		29	10	S5960_085_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	085	0		29	10	S5960_085_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	085	0		29	10	S5960_085_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	086	0		29	10	S5960_086_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	086	0		29	10	S5960_086_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	086	0		29	10	S5960_086_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	086	0		29	10	S5960_086_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	086	0		29	10	S5960_086_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	086	0		29	10	S5960_086_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	086	0		29	10	S5960_086_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	086	0		29	10	S5960_086_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	086	0		29	10	S5960_086_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	086	0		29	10	S5960_086_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	087	0		29	10	S5960_087_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	087	0		29	10	S5960_087_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	087	0		29	10	S5960_087_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	087	0		29	10	S5960_087_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	087	0		29	10	S5960_087_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	087	0		29	10	S5960_087_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	087	0		29	10	S5960_087_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	087	0		29	10	S5960_087_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	087	0		29	10	S5960_087_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	087	0		29	10	S5960_087_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	088	0		29	10	S5960_088_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	088	0		29	10	S5960_088_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	088	0		29	10	S5960_088_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	088	0		29	10	S5960_088_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	088	0		29	10	S5960_088_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	088	0		29	10	S5960_088_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	088	0		29	10	S5960_088_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	088	0		29	10	S5960_088_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	088	0		29	10	S5960_088_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	088	0		29	10	S5960_088_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	089	0		29	10	S5960_089_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	089	0		29	10	S5960_089_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	089	0		29	10	S5960_089_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	089	0		29	10	S5960_089_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	089	0		29	10	S5960_089_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	089	0		29	10	S5960_089_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	089	0		29	10	S5960_089_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	089	0		29	10	S5960_089_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	089	0		29	10	S5960_089_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	089	0		29	10	S5960_089_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	090	0		29	10	S5960_090_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	090	0		29	10	S5960_090_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	090	0		29	10	S5960_090_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	090	0		29	10	S5960_090_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	090	0		29	10	S5960_090_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	090	0		29	10	S5960_090_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	090	0		29	10	S5960_090_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	090	0		29	10	S5960_090_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	090	0		29	10	S5960_090_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	090	0		29	10	S5960_090_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	091	0		29	10	S5960_091_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	091	0		29	10	S5960_091_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	091	0		29	10	S5960_091_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	091	0		29	10	S5960_091_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	091	0		29	10	S5960_091_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	091	0		29	10	S5960_091_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	091	0		29	10	S5960_091_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	091	0		29	10	S5960_091_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	091	0		29	10	S5960_091_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	091	0		29	10	S5960_091_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	092	0		29	10	S5960_092_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	092	0		29	10	S5960_092_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	092	0		29	10	S5960_092_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	092	0		29	10	S5960_092_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	092	0		29	10	S5960_092_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	092	0		29	10	S5960_092_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	092	0		29	10	S5960_092_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	092	0		29	10	S5960_092_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	092	0		29	10	S5960_092_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	092	0		29	10	S5960_092_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	093	0		29	10	S5960_093_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	093	0		29	10	S5960_093_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	093	0		29	10	S5960_093_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	093	0		29	10	S5960_093_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	093	0		29	10	S5960_093_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	093	0		29	10	S5960_093_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	093	0		29	10	S5960_093_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	093	0		29	10	S5960_093_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	093	0		29	10	S5960_093_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	093	0		29	10	S5960_093_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	094	0		29	10	S5960_094_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	094	0		29	10	S5960_094_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	094	0		29	10	S5960_094_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	094	0		29	10	S5960_094_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	094	0		29	10	S5960_094_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	094	0		29	10	S5960_094_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	094	0		29	10	S5960_094_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	094	0		29	10	S5960_094_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	094	0		29	10	S5960_094_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	094	0		29	10	S5960_094_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	095	0		29	10	S5960_095_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	095	0		29	10	S5960_095_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	095	0		29	10	S5960_095_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	095	0		29	10	S5960_095_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	095	0		29	10	S5960_095_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	095	0		29	10	S5960_095_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	095	0		29	10	S5960_095_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	095	0		29	10	S5960_095_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	095	0		29	10	S5960_095_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	095	0		29	10	S5960_095_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	096	0		29	10	S5960_096_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	096	0		29	10	S5960_096_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	096	0		29	10	S5960_096_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	096	0		29	10	S5960_096_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	096	0		29	10	S5960_096_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	096	0		29	10	S5960_096_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	096	0		29	10	S5960_096_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	096	0		29	10	S5960_096_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	096	0		29	10	S5960_096_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	096	0		29	10	S5960_096_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	097	0		29	10	S5960_097_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	097	0		29	10	S5960_097_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	097	0		29	10	S5960_097_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	097	0		29	10	S5960_097_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	097	0		29	10	S5960_097_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	097	0		29	10	S5960_097_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	097	0		29	10	S5960_097_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	097	0		29	10	S5960_097_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	097	0		29	10	S5960_097_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	097	0		29	10	S5960_097_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	098	0		29	10	S5960_098_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	098	0		29	10	S5960_098_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	098	0		29	10	S5960_098_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	098	0		29	10	S5960_098_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	098	0		29	10	S5960_098_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	098	0		29	10	S5960_098_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	098	0		29	10	S5960_098_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	098	0		29	10	S5960_098_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	098	0		29	10	S5960_098_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	098	0		29	10	S5960_098_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	099	0		29	10	S5960_099_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	099	0		29	10	S5960_099_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	099	0		29	10	S5960_099_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	099	0		29	10	S5960_099_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	099	0		29	10	S5960_099_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	099	0		29	10	S5960_099_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	099	0		29	10	S5960_099_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	099	0		29	10	S5960_099_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	099	0		29	10	S5960_099_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	099	0		29	10	S5960_099_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	100	0		29	10	S5960_100_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	100	0		29	10	S5960_100_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	100	0		29	10	S5960_100_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	100	0		29	10	S5960_100_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	100	0		29	10	S5960_100_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	100	0		29	10	S5960_100_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	100	0		29	10	S5960_100_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	100	0		29	10	S5960_100_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	100	0		29	10	S5960_100_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	100	0		29	10	S5960_100_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	101	0		29	10	S5960_101_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	101	0		29	10	S5960_101_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	101	0		29	10	S5960_101_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	101	0		29	10	S5960_101_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	101	0		29	10	S5960_101_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	101	0		29	10	S5960_101_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	101	0		29	10	S5960_101_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	101	0		29	10	S5960_101_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	101	0		29	10	S5960_101_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	101	0		29	10	S5960_101_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	102	0		29	10	S5960_102_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	102	0		29	10	S5960_102_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	102	0		29	10	S5960_102_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	102	0		29	10	S5960_102_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	102	0		29	10	S5960_102_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	102	0		29	10	S5960_102_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	102	0		29	10	S5960_102_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	102	0		29	10	S5960_102_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	102	0		29	10	S5960_102_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	102	0		29	10	S5960_102_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	103	0		29	10	S5960_103_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	103	0		29	10	S5960_103_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	103	0		29	10	S5960_103_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	103	0		29	10	S5960_103_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	103	0		29	10	S5960_103_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	103	0		29	10	S5960_103_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	103	0		29	10	S5960_103_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	103	0		29	10	S5960_103_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	103	0		29	10	S5960_103_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	103	0		29	10	S5960_103_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	104	0		29	10	S5960_104_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	104	0		29	10	S5960_104_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	104	0		29	10	S5960_104_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	104	0		29	10	S5960_104_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	104	0		29	10	S5960_104_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	104	0		29	10	S5960_104_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	104	0		29	10	S5960_104_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5960	104	0		29	10	S5960_104_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	104	0		29	10	S5960_104_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	104	0		29	10	S5960_104_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	106	0		29	10	S5960_106_0	3	1	1	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00			4
S5960	106	0		29	10	S5960_106_0	3	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000010000001001	30	90								30							90			90		Preferred Brand	2	2		011000000010000001001	Preferred Brand																						Preferred Brand	30.00	90.00								30.00							75.00			90.00			4
S5960	106	0		29	10	S5960_106_0	3	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000010000001001	30	90								30							90			90		Non-Preferred Brand	2	2		011000000010000001001	Non-Preferred Brand																						Non-Preferred Brand	60.00	180.00								60.00							150.00			180.00			4
S5960	106	0		29	10	S5960_106_0	3	4	1	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables	011000000010000001001	30	90								30							90			90		Non-Specialty Injectables	2	1	011000000010000001001		Non-Specialty Injectables	30	30								30							25			25		Non-Specialty Injectables																							4
S5960	106	0		29	10	S5960_106_0	3	5	3	Specialty Injectables	010010	1	1	Specialty Injectables																							Specialty Injectables					Specialty Injectables																						Specialty Injectables																						2	4
S5960	106	0		29	10	S5960_106_0	3	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5960	106	0		29	10	S5960_106_0	3	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5960	106	0		29	10	S5960_106_0	3	1	3	Generic	010000	3	2	Generic	011000000010000001001	30	90								30							90			90		Generic	2	2		011000000010000001001	Generic																						Generic	10.00	30.00								10.00							15.00			30.00		1	4
S5960	106	0		29	10	S5960_106_0	3	5	1	Specialty Injectables	010010	1	1	Specialty Injectables	011000000010000001001	30	90								30							90			90		Specialty Injectables	2	1	011000000010000001001		Specialty Injectables	30	30								30							25			25		Specialty Injectables																							4
S5960	106	0		29	10	S5960_106_0	3	4	3	Non-Specialty Injectables	010010	1	2	Non-Specialty Injectables																							Non-Specialty Injectables					Non-Specialty Injectables																						Non-Specialty Injectables																						2	4
S5967	035	0		29	10	S5967_035_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	035	0		29	10	S5967_035_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	035	0		29	10	S5967_035_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									3
S5967	035	0		29	10	S5967_035_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	036	0		29	10	S5967_036_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	036	0		29	10	S5967_036_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	036	0		29	10	S5967_036_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	88.00	264.00								88.00	264.00			264.00									3
S5967	036	0		29	10	S5967_036_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	037	0		29	10	S5967_037_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	037	0		29	10	S5967_037_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	037	0		29	10	S5967_037_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	037	0		29	10	S5967_037_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	87.00	261.00								87.00	261.00			261.00									3
S5967	038	0		29	10	S5967_038_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	038	0		29	10	S5967_038_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	58.00	174.00								58.00	174.00			174.00									3
S5967	038	0		29	10	S5967_038_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	88.00	264.00								88.00	264.00			264.00									3
S5967	038	0		29	10	S5967_038_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	31	31								31	31			31								Tier 4																							3
S5967	039	0		29	10	S5967_039_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	039	0		29	10	S5967_039_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									3
S5967	039	0		29	10	S5967_039_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	039	0		29	10	S5967_039_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	040	0		29	10	S5967_040_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	040	0		29	10	S5967_040_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	040	0		29	10	S5967_040_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	83.00	249.00								83.00	249.00			249.00									3
S5967	040	0		29	10	S5967_040_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	041	0		29	10	S5967_041_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	041	0		29	10	S5967_041_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	86.00	258.00								86.00	258.00			258.00									3
S5967	041	0		29	10	S5967_041_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	041	0		29	10	S5967_041_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	042	0		29	10	S5967_042_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	86.00	258.00								86.00	258.00			258.00									3
S5967	042	0		29	10	S5967_042_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	042	0		29	10	S5967_042_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	042	0		29	10	S5967_042_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	043	0		29	10	S5967_043_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	043	0		29	10	S5967_043_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	88.00	264.00								88.00	264.00			264.00									3
S5967	043	0		29	10	S5967_043_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	043	0		29	10	S5967_043_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	044	0		29	10	S5967_044_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	88.00	264.00								88.00	264.00			264.00									3
S5967	044	0		29	10	S5967_044_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	044	0		29	10	S5967_044_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	044	0		29	10	S5967_044_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	045	0		29	10	S5967_045_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	045	0		29	10	S5967_045_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	89.00	267.00								89.00	267.00			267.00									3
S5967	045	0		29	10	S5967_045_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	045	0		29	10	S5967_045_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	046	0		29	10	S5967_046_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	80.00	240.00								80.00	240.00			240.00									3
S5967	046	0		29	10	S5967_046_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	046	0		29	10	S5967_046_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	046	0		29	10	S5967_046_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	047	0		29	10	S5967_047_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	047	0		29	10	S5967_047_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	87.00	261.00								87.00	261.00			261.00									3
S5967	047	0		29	10	S5967_047_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	047	0		29	10	S5967_047_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	048	0		29	10	S5967_048_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	80.00	240.00								80.00	240.00			240.00									3
S5967	048	0		29	10	S5967_048_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	048	0		29	10	S5967_048_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	048	0		29	10	S5967_048_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	049	0		29	10	S5967_049_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	049	0		29	10	S5967_049_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	049	0		29	10	S5967_049_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	84.00	252.00								84.00	252.00			252.00									3
S5967	049	0		29	10	S5967_049_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	050	0		29	10	S5967_050_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	87.00	261.00								87.00	261.00			261.00									3
S5967	050	0		29	10	S5967_050_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	050	0		29	10	S5967_050_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	050	0		29	10	S5967_050_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	051	0		29	10	S5967_051_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	051	0		29	10	S5967_051_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	87.00	261.00								87.00	261.00			261.00									3
S5967	051	0		29	10	S5967_051_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	051	0		29	10	S5967_051_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	052	0		29	10	S5967_052_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	052	0		29	10	S5967_052_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	85.00	255.00								85.00	255.00			255.00									3
S5967	052	0		29	10	S5967_052_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	58.00	174.00								58.00	174.00			174.00									3
S5967	052	0		29	10	S5967_052_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	053	0		29	10	S5967_053_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	32	32								32	32			32								Tier 4																							3
S5967	053	0		29	10	S5967_053_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	91.00	273.00								91.00	273.00			273.00									3
S5967	053	0		29	10	S5967_053_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	59.00	177.00								59.00	177.00			177.00									3
S5967	053	0		29	10	S5967_053_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	054	0		29	10	S5967_054_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	054	0		29	10	S5967_054_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	89.00	267.00								89.00	267.00			267.00									3
S5967	054	0		29	10	S5967_054_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	054	0		29	10	S5967_054_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	055	0		29	10	S5967_055_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	89.00	267.00								89.00	267.00			267.00									3
S5967	055	0		29	10	S5967_055_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	055	0		29	10	S5967_055_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	055	0		29	10	S5967_055_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	056	0		29	10	S5967_056_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	056	0		29	10	S5967_056_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	056	0		29	10	S5967_056_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	056	0		29	10	S5967_056_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	90.00	270.00								90.00	270.00			270.00									3
S5967	057	0		29	10	S5967_057_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	89.00	267.00								89.00	267.00			267.00									3
S5967	057	0		29	10	S5967_057_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	057	0		29	10	S5967_057_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	057	0		29	10	S5967_057_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	058	0		29	10	S5967_058_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	058	0		29	10	S5967_058_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	058	0		29	10	S5967_058_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	058	0		29	10	S5967_058_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	87.00	261.00								87.00	261.00			261.00									3
S5967	059	0		29	10	S5967_059_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	059	0		29	10	S5967_059_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	89.00	267.00								89.00	267.00			267.00									3
S5967	059	0		29	10	S5967_059_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	059	0		29	10	S5967_059_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	060	0		29	10	S5967_060_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	060	0		29	10	S5967_060_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	060	0		29	10	S5967_060_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	89.00	267.00								89.00	267.00			267.00									3
S5967	060	0		29	10	S5967_060_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	061	0		29	10	S5967_061_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	061	0		29	10	S5967_061_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	58.00	174.00								58.00	174.00			174.00									3
S5967	061	0		29	10	S5967_061_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	91.00	273.00								91.00	273.00			273.00									3
S5967	061	0		29	10	S5967_061_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	32	32								32	32			32								Tier 4																							3
S5967	062	0		29	10	S5967_062_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	58.00	174.00								58.00	174.00			174.00									3
S5967	062	0		29	10	S5967_062_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	062	0		29	10	S5967_062_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	91.00	273.00								91.00	273.00			273.00									3
S5967	062	0		29	10	S5967_062_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	063	0		29	10	S5967_063_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	93.00	279.00								93.00	279.00			279.00									3
S5967	063	0		29	10	S5967_063_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	063	0		29	10	S5967_063_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	58.00	174.00								58.00	174.00			174.00									3
S5967	063	0		29	10	S5967_063_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	32	32								32	32			32								Tier 4																							3
S5967	064	0		29	10	S5967_064_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	064	0		29	10	S5967_064_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	57.00	171.00								57.00	171.00			171.00									3
S5967	064	0		29	10	S5967_064_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	89.00	267.00								89.00	267.00			267.00									3
S5967	064	0		29	10	S5967_064_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	065	0		29	10	S5967_065_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	065	0		29	10	S5967_065_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	065	0		29	10	S5967_065_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	58.00	174.00								58.00	174.00			174.00									3
S5967	065	0		29	10	S5967_065_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	88.00	264.00								88.00	264.00			264.00									3
S5967	066	0		29	10	S5967_066_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	92.00	276.00								92.00	276.00			276.00									3
S5967	066	0		29	10	S5967_066_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	066	0		29	10	S5967_066_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	58.00	174.00								58.00	174.00			174.00									3
S5967	066	0		29	10	S5967_066_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	067	0		29	10	S5967_067_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	067	0		29	10	S5967_067_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	58.00	174.00								58.00	174.00			174.00									3
S5967	067	0		29	10	S5967_067_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	90.00	270.00								90.00	270.00			270.00									3
S5967	067	0		29	10	S5967_067_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	33	33								33	33			33								Tier 4																							3
S5967	068	0		29	10	S5967_068_0	4	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	56.00	168.00								56.00	168.00			168.00									3
S5967	068	0		29	10	S5967_068_0	4	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	88.00	264.00								88.00	264.00			264.00									3
S5967	068	0		29	10	S5967_068_0	4	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	32	32								32	32			32								Tier 4																							3
S5967	068	0		29	10	S5967_068_0	4	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									3
S5967	069	0		29	10	S5967_069_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	069	0		29	10	S5967_069_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	069	0		29	10	S5967_069_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	069	0		29	10	S5967_069_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	069	0		29	10	S5967_069_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	069	0		29	10	S5967_069_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	069	0		29	10	S5967_069_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	069	0		29	10	S5967_069_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	070	0		29	10	S5967_070_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	070	0		29	10	S5967_070_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	070	0		29	10	S5967_070_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	070	0		29	10	S5967_070_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	070	0		29	10	S5967_070_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	070	0		29	10	S5967_070_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	070	0		29	10	S5967_070_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	070	0		29	10	S5967_070_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	071	0		29	10	S5967_071_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	071	0		29	10	S5967_071_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	071	0		29	10	S5967_071_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	071	0		29	10	S5967_071_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	071	0		29	10	S5967_071_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	071	0		29	10	S5967_071_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	071	0		29	10	S5967_071_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	071	0		29	10	S5967_071_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	072	0		29	10	S5967_072_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	072	0		29	10	S5967_072_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	072	0		29	10	S5967_072_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	072	0		29	10	S5967_072_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	072	0		29	10	S5967_072_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	072	0		29	10	S5967_072_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	072	0		29	10	S5967_072_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	072	0		29	10	S5967_072_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	073	0		29	10	S5967_073_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	073	0		29	10	S5967_073_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	073	0		29	10	S5967_073_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	073	0		29	10	S5967_073_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	073	0		29	10	S5967_073_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	073	0		29	10	S5967_073_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	073	0		29	10	S5967_073_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	073	0		29	10	S5967_073_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	074	0		29	10	S5967_074_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	074	0		29	10	S5967_074_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	074	0		29	10	S5967_074_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	074	0		29	10	S5967_074_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	074	0		29	10	S5967_074_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	074	0		29	10	S5967_074_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	074	0		29	10	S5967_074_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	074	0		29	10	S5967_074_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	075	0		29	10	S5967_075_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	075	0		29	10	S5967_075_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	075	0		29	10	S5967_075_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	075	0		29	10	S5967_075_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	075	0		29	10	S5967_075_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	075	0		29	10	S5967_075_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	075	0		29	10	S5967_075_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	075	0		29	10	S5967_075_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	076	0		29	10	S5967_076_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	076	0		29	10	S5967_076_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	076	0		29	10	S5967_076_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	076	0		29	10	S5967_076_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	076	0		29	10	S5967_076_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	076	0		29	10	S5967_076_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	076	0		29	10	S5967_076_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	076	0		29	10	S5967_076_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	077	0		29	10	S5967_077_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	077	0		29	10	S5967_077_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	077	0		29	10	S5967_077_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	077	0		29	10	S5967_077_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	077	0		29	10	S5967_077_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	077	0		29	10	S5967_077_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	077	0		29	10	S5967_077_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	077	0		29	10	S5967_077_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	078	0		29	10	S5967_078_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	078	0		29	10	S5967_078_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	078	0		29	10	S5967_078_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	078	0		29	10	S5967_078_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	078	0		29	10	S5967_078_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	078	0		29	10	S5967_078_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	078	0		29	10	S5967_078_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	078	0		29	10	S5967_078_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	079	0		29	10	S5967_079_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	079	0		29	10	S5967_079_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	079	0		29	10	S5967_079_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	079	0		29	10	S5967_079_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	079	0		29	10	S5967_079_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	079	0		29	10	S5967_079_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	079	0		29	10	S5967_079_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	079	0		29	10	S5967_079_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	080	0		29	10	S5967_080_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	080	0		29	10	S5967_080_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	080	0		29	10	S5967_080_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	080	0		29	10	S5967_080_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	080	0		29	10	S5967_080_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	080	0		29	10	S5967_080_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	080	0		29	10	S5967_080_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	080	0		29	10	S5967_080_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	081	0		29	10	S5967_081_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	081	0		29	10	S5967_081_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	081	0		29	10	S5967_081_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	081	0		29	10	S5967_081_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	081	0		29	10	S5967_081_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	081	0		29	10	S5967_081_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	081	0		29	10	S5967_081_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	081	0		29	10	S5967_081_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	082	0		29	10	S5967_082_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	082	0		29	10	S5967_082_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	082	0		29	10	S5967_082_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	082	0		29	10	S5967_082_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	082	0		29	10	S5967_082_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	082	0		29	10	S5967_082_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	082	0		29	10	S5967_082_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	082	0		29	10	S5967_082_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	083	0		29	10	S5967_083_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	083	0		29	10	S5967_083_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	083	0		29	10	S5967_083_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	083	0		29	10	S5967_083_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	083	0		29	10	S5967_083_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	083	0		29	10	S5967_083_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	083	0		29	10	S5967_083_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	083	0		29	10	S5967_083_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	084	0		29	10	S5967_084_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	084	0		29	10	S5967_084_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	084	0		29	10	S5967_084_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	084	0		29	10	S5967_084_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	084	0		29	10	S5967_084_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	084	0		29	10	S5967_084_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	084	0		29	10	S5967_084_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	084	0		29	10	S5967_084_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	085	0		29	10	S5967_085_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	085	0		29	10	S5967_085_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	085	0		29	10	S5967_085_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	085	0		29	10	S5967_085_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	085	0		29	10	S5967_085_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	085	0		29	10	S5967_085_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	085	0		29	10	S5967_085_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	085	0		29	10	S5967_085_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	086	0		29	10	S5967_086_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	086	0		29	10	S5967_086_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	086	0		29	10	S5967_086_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	086	0		29	10	S5967_086_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	086	0		29	10	S5967_086_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	086	0		29	10	S5967_086_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	086	0		29	10	S5967_086_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	086	0		29	10	S5967_086_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	087	0		29	10	S5967_087_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	087	0		29	10	S5967_087_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	087	0		29	10	S5967_087_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	087	0		29	10	S5967_087_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	087	0		29	10	S5967_087_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	087	0		29	10	S5967_087_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	087	0		29	10	S5967_087_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	087	0		29	10	S5967_087_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	088	0		29	10	S5967_088_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	088	0		29	10	S5967_088_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	088	0		29	10	S5967_088_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	088	0		29	10	S5967_088_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	088	0		29	10	S5967_088_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	088	0		29	10	S5967_088_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	088	0		29	10	S5967_088_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	088	0		29	10	S5967_088_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	089	0		29	10	S5967_089_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	089	0		29	10	S5967_089_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	089	0		29	10	S5967_089_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	089	0		29	10	S5967_089_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	089	0		29	10	S5967_089_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	089	0		29	10	S5967_089_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	089	0		29	10	S5967_089_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	089	0		29	10	S5967_089_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	090	0		29	10	S5967_090_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	090	0		29	10	S5967_090_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	090	0		29	10	S5967_090_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	090	0		29	10	S5967_090_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	090	0		29	10	S5967_090_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	090	0		29	10	S5967_090_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	090	0		29	10	S5967_090_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	090	0		29	10	S5967_090_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	092	0		29	10	S5967_092_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	092	0		29	10	S5967_092_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	092	0		29	10	S5967_092_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	092	0		29	10	S5967_092_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	092	0		29	10	S5967_092_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	092	0		29	10	S5967_092_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	092	0		29	10	S5967_092_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	092	0		29	10	S5967_092_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	093	0		29	10	S5967_093_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	093	0		29	10	S5967_093_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	093	0		29	10	S5967_093_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	093	0		29	10	S5967_093_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	093	0		29	10	S5967_093_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	093	0		29	10	S5967_093_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	093	0		29	10	S5967_093_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	093	0		29	10	S5967_093_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	094	0		29	10	S5967_094_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	094	0		29	10	S5967_094_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	094	0		29	10	S5967_094_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	094	0		29	10	S5967_094_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	094	0		29	10	S5967_094_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	094	0		29	10	S5967_094_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	094	0		29	10	S5967_094_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	094	0		29	10	S5967_094_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	095	0		29	10	S5967_095_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	095	0		29	10	S5967_095_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	095	0		29	10	S5967_095_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	095	0		29	10	S5967_095_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	095	0		29	10	S5967_095_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	095	0		29	10	S5967_095_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	095	0		29	10	S5967_095_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	095	0		29	10	S5967_095_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	096	0		29	10	S5967_096_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	096	0		29	10	S5967_096_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	096	0		29	10	S5967_096_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	096	0		29	10	S5967_096_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	096	0		29	10	S5967_096_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	096	0		29	10	S5967_096_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	096	0		29	10	S5967_096_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	096	0		29	10	S5967_096_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	097	0		29	10	S5967_097_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	097	0		29	10	S5967_097_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	097	0		29	10	S5967_097_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	097	0		29	10	S5967_097_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	097	0		29	10	S5967_097_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	097	0		29	10	S5967_097_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	097	0		29	10	S5967_097_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	097	0		29	10	S5967_097_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	098	0		29	10	S5967_098_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	098	0		29	10	S5967_098_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	098	0		29	10	S5967_098_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	098	0		29	10	S5967_098_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	098	0		29	10	S5967_098_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	098	0		29	10	S5967_098_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	098	0		29	10	S5967_098_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	098	0		29	10	S5967_098_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	099	0		29	10	S5967_099_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	099	0		29	10	S5967_099_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	099	0		29	10	S5967_099_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	099	0		29	10	S5967_099_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	099	0		29	10	S5967_099_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	099	0		29	10	S5967_099_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	099	0		29	10	S5967_099_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	099	0		29	10	S5967_099_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	100	0		29	10	S5967_100_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	100	0		29	10	S5967_100_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	100	0		29	10	S5967_100_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	100	0		29	10	S5967_100_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	100	0		29	10	S5967_100_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	100	0		29	10	S5967_100_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	100	0		29	10	S5967_100_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	100	0		29	10	S5967_100_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	101	0		29	10	S5967_101_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	101	0		29	10	S5967_101_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	101	0		29	10	S5967_101_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	101	0		29	10	S5967_101_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	101	0		29	10	S5967_101_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	101	0		29	10	S5967_101_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	101	0		29	10	S5967_101_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	101	0		29	10	S5967_101_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	102	0		29	10	S5967_102_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	102	0		29	10	S5967_102_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	102	0		29	10	S5967_102_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	102	0		29	10	S5967_102_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	102	0		29	10	S5967_102_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	102	0		29	10	S5967_102_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	102	0		29	10	S5967_102_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	102	0		29	10	S5967_102_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	103	0		29	10	S5967_103_0	1	4	1	Tier 4	000010	1	1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	30	30								30	30			30								Tier 4																							4
S5967	103	0		29	10	S5967_103_0	1	3	1	Tier 3	100000	1	2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	2		011000000011001000000	Tier 3																						Tier 3	70.00	210.00								70.00	210.00			210.00									4
S5967	103	0		29	10	S5967_103_0	1	2	1	Tier 2	000001	1	2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	2		011000000011001000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00			60.00									4
S5967	103	0		29	10	S5967_103_0	1	1	1	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00			0.00									4
S5967	103	0		29	10	S5967_103_0	1	1	3	Tier 1	010000	1	2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	10.00	30.00								10.00	30.00			30.00								1	4
S5967	103	0		29	10	S5967_103_0	1	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S5967	103	0		29	10	S5967_103_0	1	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S5967	103	0		29	10	S5967_103_0	1	4	3	Tier 4	000010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S5967	138	0		29	10	S5967_138_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	138	0		29	10	S5967_138_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	138	0		29	10	S5967_138_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	138	0		29	10	S5967_138_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	139	0		29	10	S5967_139_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	139	0		29	10	S5967_139_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	139	0		29	10	S5967_139_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	139	0		29	10	S5967_139_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	140	0		29	10	S5967_140_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	140	0		29	10	S5967_140_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	140	0		29	10	S5967_140_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	140	0		29	10	S5967_140_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	141	0		29	10	S5967_141_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	141	0		29	10	S5967_141_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	141	0		29	10	S5967_141_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	141	0		29	10	S5967_141_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	142	0		29	10	S5967_142_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	142	0		29	10	S5967_142_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	142	0		29	10	S5967_142_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	142	0		29	10	S5967_142_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	143	0		29	10	S5967_143_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	143	0		29	10	S5967_143_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	143	0		29	10	S5967_143_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	143	0		29	10	S5967_143_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	144	0		29	10	S5967_144_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	144	0		29	10	S5967_144_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	144	0		29	10	S5967_144_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	144	0		29	10	S5967_144_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	145	0		29	10	S5967_145_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	145	0		29	10	S5967_145_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	145	0		29	10	S5967_145_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	145	0		29	10	S5967_145_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	146	0		29	10	S5967_146_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	146	0		29	10	S5967_146_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	146	0		29	10	S5967_146_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	146	0		29	10	S5967_146_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	147	0		29	10	S5967_147_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	147	0		29	10	S5967_147_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	147	0		29	10	S5967_147_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	147	0		29	10	S5967_147_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	148	0		29	10	S5967_148_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	148	0		29	10	S5967_148_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	35	35								35	35			35								Tier 3																							2
S5967	148	0		29	10	S5967_148_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	35	35								35	35			35								Tier 2																							2
S5967	148	0		29	10	S5967_148_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	149	0		29	10	S5967_149_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	149	0		29	10	S5967_149_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	149	0		29	10	S5967_149_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	149	0		29	10	S5967_149_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	150	0		29	10	S5967_150_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	150	0		29	10	S5967_150_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	150	0		29	10	S5967_150_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	150	0		29	10	S5967_150_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	151	0		29	10	S5967_151_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	151	0		29	10	S5967_151_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	151	0		29	10	S5967_151_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	151	0		29	10	S5967_151_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	152	0		29	10	S5967_152_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	152	0		29	10	S5967_152_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	152	0		29	10	S5967_152_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	152	0		29	10	S5967_152_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	153	0		29	10	S5967_153_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	153	0		29	10	S5967_153_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	153	0		29	10	S5967_153_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	153	0		29	10	S5967_153_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	154	0		29	10	S5967_154_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	154	0		29	10	S5967_154_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	154	0		29	10	S5967_154_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	154	0		29	10	S5967_154_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	155	0		29	10	S5967_155_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	155	0		29	10	S5967_155_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	155	0		29	10	S5967_155_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	155	0		29	10	S5967_155_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	156	0		29	10	S5967_156_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	156	0		29	10	S5967_156_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	156	0		29	10	S5967_156_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	156	0		29	10	S5967_156_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	157	0		29	10	S5967_157_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	157	0		29	10	S5967_157_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	157	0		29	10	S5967_157_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	157	0		29	10	S5967_157_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	158	0		29	10	S5967_158_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	158	0		29	10	S5967_158_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	158	0		29	10	S5967_158_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	158	0		29	10	S5967_158_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	159	0		29	10	S5967_159_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	159	0		29	10	S5967_159_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	159	0		29	10	S5967_159_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	159	0		29	10	S5967_159_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	160	0		29	10	S5967_160_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	160	0		29	10	S5967_160_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	160	0		29	10	S5967_160_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	160	0		29	10	S5967_160_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	161	0		29	10	S5967_161_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	161	0		29	10	S5967_161_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	161	0		29	10	S5967_161_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	161	0		29	10	S5967_161_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	162	0		29	10	S5967_162_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	162	0		29	10	S5967_162_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	162	0		29	10	S5967_162_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	162	0		29	10	S5967_162_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	163	0		29	10	S5967_163_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	163	0		29	10	S5967_163_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	163	0		29	10	S5967_163_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	163	0		29	10	S5967_163_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	164	0		29	10	S5967_164_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	164	0		29	10	S5967_164_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	164	0		29	10	S5967_164_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	164	0		29	10	S5967_164_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	165	0		29	10	S5967_165_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	35	35								35	35			35								Tier 3																							2
S5967	165	0		29	10	S5967_165_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	35	35								35	35			35								Tier 2																							2
S5967	165	0		29	10	S5967_165_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	165	0		29	10	S5967_165_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	166	0		29	10	S5967_166_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	35	35								35	35			35								Tier 3																							2
S5967	166	0		29	10	S5967_166_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	35	35								35	35			35								Tier 2																							2
S5967	166	0		29	10	S5967_166_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	166	0		29	10	S5967_166_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	167	0		29	10	S5967_167_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	167	0		29	10	S5967_167_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	167	0		29	10	S5967_167_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	167	0		29	10	S5967_167_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	168	0		29	10	S5967_168_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	168	0		29	10	S5967_168_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	168	0		29	10	S5967_168_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	168	0		29	10	S5967_168_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	169	0		29	10	S5967_169_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	35	35								35	35			35								Tier 3																							2
S5967	169	0		29	10	S5967_169_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	169	0		29	10	S5967_169_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	35	35								35	35			35								Tier 2																							2
S5967	169	0		29	10	S5967_169_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	170	0		29	10	S5967_170_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5967	170	0		29	10	S5967_170_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	34	34								34	34			34								Tier 3																							2
S5967	170	0		29	10	S5967_170_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	34	34								34	34			34								Tier 2																							2
S5967	170	0		29	10	S5967_170_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	171	0		29	10	S5967_171_0	2	1	1	Tier 1	010000		2	Tier 1	011000000011001000000	30	90								30	90			90								Tier 1	1	2		011000000011001000000	Tier 1																						Tier 1	2.00	6.00								2.00	6.00			6.00									2
S5967	171	0		29	10	S5967_171_0	2	2	1	Tier 2	000001		2	Tier 2	011000000011001000000	30	90								30	90			90								Tier 2	1	1	011000000011001000000		Tier 2	33	33								33	33			33								Tier 2																							2
S5967	171	0		29	10	S5967_171_0	2	3	1	Tier 3	100000		2	Tier 3	011000000011001000000	30	90								30	90			90								Tier 3	1	1	011000000011001000000		Tier 3	33	33								33	33			33								Tier 3																							2
S5967	171	0		29	10	S5967_171_0	2	4	1	Tier 4	000010		1	Tier 4	011000000011001000000	30	90								30	90			90								Tier 4	1	1	011000000011001000000		Tier 4	25	25								25	25			25								Tier 4																							2
S5975	002	0		29	10	S5975_002_0	3	2	3	Brand/Inj/Specialty	100011	1	2	Brand/Inj/Specialty																							Brand/Inj/Specialty					Brand/Inj/Specialty																						Brand/Inj/Specialty																						2	4
S5975	002	0		29	10	S5975_002_0	3	1	3	Generic	011100	1	2	Generic	011000000011011000000	30	90								30	90		30	90								Generic	1	1	011000000011011000000		Generic	25	25								25	25		25	25								Generic																						1	4
S5983	001	0		29	10	S5983_001_0	4	1	1	Generic	010000		2	Generic	011100000010001000000	34	90	60							34				90								Generic	2	2		011100000010001000000	Generic																						Generic	5.00	15.00	10.00							5.00				5.00									3
S5983	001	0		29	10	S5983_001_0	4	4	1	Specialty	000010		1	Specialty	011100000010001000000	34	90	60							34				90								Specialty	2	1	011100000010001000000		Specialty	30	30	30							30				30								Specialty																							3
S5983	001	0		29	10	S5983_001_0	4	3	1	Non-Preferred	100000		2	Non-Preferred	011100000010001000000	34	90	60							34				90								Non-Preferred	2	1	011100000010001000000		Non-Preferred	75	75	75							75				75								Non-Preferred																							3
S5983	001	0		29	10	S5983_001_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011100000010001000000	34	90	60							34				90								Preferred Brand	2	2		011100000010001000000	Preferred Brand																						Preferred Brand	34.00	102.00	68.00							34.00				85.00									3
S5993	001	0		29	10	S5993_001_0	4	1	1	Generic	010000		2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	5.00	15.00								5.00	15.00			15.00									2
S5993	001	0		29	10	S5993_001_0	4	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	22.00	66.00								22.00	66.00			66.00									2
S5993	001	0		29	10	S5993_001_0	4	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	44.00	132.00								44.00	132.00			132.00									2
S5993	001	0		29	10	S5993_001_0	4	4	1	Specialty	010011		1	Specialty	011000000011000000000	30	90								30	90											Specialty	1	1	011000000011000000000		Specialty	25	25								25	25											Specialty																							2
S5993	002	0		29	10	S5993_002_0	4	3	1	Non-Preferred Brand	100000	1	2	Non-Preferred Brand	011000000011001000000	30	90								30	90			90								Non-Preferred Brand	1	2		011000000011001000000	Non-Preferred Brand																						Non-Preferred Brand	39.00	117.00								39.00	117.00			117.00									4
S5993	002	0		29	10	S5993_002_0	4	2	1	Preferred Brand	000001	1	2	Preferred Brand	011000000011001000000	30	90								30	90			90								Preferred Brand	1	2		011000000011001000000	Preferred Brand																						Preferred Brand	20.00	60.00								20.00	60.00			60.00									4
S5993	002	0		29	10	S5993_002_0	4	1	1	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	10.00	30.00								10.00	30.00			30.00									4
S5993	002	0		29	10	S5993_002_0	4	4	1	Specialty	010011	1	1	Specialty	011000000011000000000	30	90								30	90											Specialty	1	1	011000000011000000000		Specialty	25	25								25	25											Specialty																							4
S5993	002	0		29	10	S5993_002_0	4	4	3	Specialty	010011	1	1	Specialty																							Specialty					Specialty																						Specialty																						2	4
S5993	002	0		29	10	S5993_002_0	4	3	3	Non-Preferred Brand	100000	1	2	Non-Preferred Brand																							Non-Preferred Brand					Non-Preferred Brand																						Non-Preferred Brand																						2	4
S5993	002	0		29	10	S5993_002_0	4	2	3	Preferred Brand	000001	1	2	Preferred Brand																							Preferred Brand					Preferred Brand																						Preferred Brand																						2	4
S5993	002	0		29	10	S5993_002_0	4	1	3	Generic	010000	1	2	Generic	011000000011001000000	30	90								30	90			90								Generic	1	2		011000000011001000000	Generic																						Generic	10.00	30.00								10.00	30.00			30.00								1	4
S5998	002	0		29	10	S5998_002_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00		33.00	66.00									3
S5998	002	0		29	10	S5998_002_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S5998	002	0		29	10	S5998_002_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	63.00	189.00								63.00	189.00		63.00	126.00									3
S5998	002	0		29	10	S5998_002_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5998	004	0		29	10	S5998_004_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	63.00	189.00								63.00	189.00		63.00	126.00									3
S5998	004	0		29	10	S5998_004_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	33.00	99.00								33.00	99.00		33.00	66.00									3
S5998	004	0		29	10	S5998_004_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S5998	004	0		29	10	S5998_004_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5998	006	0		29	10	S5998_006_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S5998	006	0		29	10	S5998_006_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00	96.00		32.00	64.00									3
S5998	006	0		29	10	S5998_006_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	62.00	186.00								62.00	186.00		62.00	124.00									3
S5998	006	0		29	10	S5998_006_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5998	008	0		29	10	S5998_008_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S5998	008	0		29	10	S5998_008_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									3
S5998	008	0		29	10	S5998_008_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	60.00	180.00								60.00	180.00		60.00	120.00									3
S5998	008	0		29	10	S5998_008_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5998	010	0		29	10	S5998_010_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S5998	010	0		29	10	S5998_010_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									3
S5998	010	0		29	10	S5998_010_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5998	010	0		29	10	S5998_010_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	60.00	180.00								60.00	180.00		60.00	120.00									3
S5998	012	0		29	10	S5998_012_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S5998	012	0		29	10	S5998_012_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	30.00	90.00								30.00	90.00		30.00	60.00									3
S5998	012	0		29	10	S5998_012_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	60.00	180.00								60.00	180.00		60.00	120.00									3
S5998	012	0		29	10	S5998_012_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S5998	014	0		29	10	S5998_014_0	3	1	1	Generic	010000		2	Generic	011000000011011000000	31	90								31	90		31	90								Generic	2	2		011000000011011000000	Generic																						Generic	5.00	15.00								5.00	15.00		5.00	10.00									3
S5998	014	0		29	10	S5998_014_0	3	3	1	Non-Preferred  Brand	100000		2	Non-Preferred  Brand	011000000011011000000	31	90								31	90		31	90								Non-Preferred  Brand	2	2		011000000011011000000	Non-Preferred  Brand																						Non-Preferred  Brand	64.00	192.00								64.00	192.00		64.00	128.00									3
S5998	014	0		29	10	S5998_014_0	3	2	1	Preferred Brand	000001		2	Preferred Brand	011000000011011000000	31	90								31	90		31	90								Preferred Brand	2	2		011000000011011000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00	96.00		32.00	64.00									3
S5998	014	0		29	10	S5998_014_0	3	4	1	Specialty	000010		1	Specialty	011000000011011000000	31	90								31	90		31	90								Specialty	2	1	011000000011011000000		Specialty	25	25								25	25		25	25								Specialty																							3
S7694	035	0		29	10	S7694_035_0	6	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	035	0		29	10	S7694_035_0	6	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	035	0		29	10	S7694_035_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	035	0		29	10	S7694_035_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	035	0		29	10	S7694_035_0	6	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	035	0		29	10	S7694_035_0	6	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	035	0		29	10	S7694_035_0	6	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	035	0		29	10	S7694_035_0	6	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	036	0		29	10	S7694_036_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	036	0		29	10	S7694_036_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	036	0		29	10	S7694_036_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	036	0		29	10	S7694_036_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	036	0		29	10	S7694_036_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	036	0		29	10	S7694_036_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	036	0		29	10	S7694_036_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	036	0		29	10	S7694_036_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	037	0		29	10	S7694_037_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	037	0		29	10	S7694_037_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	037	0		29	10	S7694_037_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	037	0		29	10	S7694_037_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	037	0		29	10	S7694_037_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	037	0		29	10	S7694_037_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	037	0		29	10	S7694_037_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	037	0		29	10	S7694_037_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	038	0		29	10	S7694_038_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	038	0		29	10	S7694_038_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	038	0		29	10	S7694_038_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	038	0		29	10	S7694_038_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	038	0		29	10	S7694_038_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	038	0		29	10	S7694_038_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	038	0		29	10	S7694_038_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	038	0		29	10	S7694_038_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	039	0		29	10	S7694_039_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	039	0		29	10	S7694_039_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	039	0		29	10	S7694_039_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	039	0		29	10	S7694_039_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	039	0		29	10	S7694_039_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	039	0		29	10	S7694_039_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	039	0		29	10	S7694_039_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	039	0		29	10	S7694_039_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	040	0		29	10	S7694_040_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	040	0		29	10	S7694_040_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	040	0		29	10	S7694_040_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	040	0		29	10	S7694_040_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	040	0		29	10	S7694_040_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	040	0		29	10	S7694_040_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	040	0		29	10	S7694_040_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	040	0		29	10	S7694_040_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	041	0		29	10	S7694_041_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	041	0		29	10	S7694_041_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	041	0		29	10	S7694_041_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	041	0		29	10	S7694_041_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	041	0		29	10	S7694_041_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	041	0		29	10	S7694_041_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	041	0		29	10	S7694_041_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	041	0		29	10	S7694_041_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	042	0		29	10	S7694_042_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	042	0		29	10	S7694_042_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	042	0		29	10	S7694_042_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	042	0		29	10	S7694_042_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	042	0		29	10	S7694_042_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	042	0		29	10	S7694_042_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	042	0		29	10	S7694_042_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	042	0		29	10	S7694_042_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	043	0		29	10	S7694_043_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	043	0		29	10	S7694_043_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	043	0		29	10	S7694_043_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	043	0		29	10	S7694_043_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	043	0		29	10	S7694_043_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	043	0		29	10	S7694_043_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	043	0		29	10	S7694_043_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	043	0		29	10	S7694_043_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	044	0		29	10	S7694_044_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	044	0		29	10	S7694_044_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	044	0		29	10	S7694_044_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	044	0		29	10	S7694_044_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	044	0		29	10	S7694_044_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	044	0		29	10	S7694_044_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	044	0		29	10	S7694_044_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	044	0		29	10	S7694_044_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	045	0		29	10	S7694_045_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	045	0		29	10	S7694_045_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	045	0		29	10	S7694_045_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	045	0		29	10	S7694_045_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	045	0		29	10	S7694_045_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	045	0		29	10	S7694_045_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	045	0		29	10	S7694_045_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	045	0		29	10	S7694_045_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	046	0		29	10	S7694_046_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	046	0		29	10	S7694_046_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	046	0		29	10	S7694_046_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	046	0		29	10	S7694_046_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	046	0		29	10	S7694_046_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	046	0		29	10	S7694_046_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	046	0		29	10	S7694_046_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	046	0		29	10	S7694_046_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	047	0		29	10	S7694_047_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	047	0		29	10	S7694_047_0	6	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	047	0		29	10	S7694_047_0	6	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	047	0		29	10	S7694_047_0	6	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	047	0		29	10	S7694_047_0	6	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	047	0		29	10	S7694_047_0	6	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	047	0		29	10	S7694_047_0	6	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	047	0		29	10	S7694_047_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	048	0		29	10	S7694_048_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	048	0		29	10	S7694_048_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	048	0		29	10	S7694_048_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	048	0		29	10	S7694_048_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	048	0		29	10	S7694_048_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	048	0		29	10	S7694_048_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	048	0		29	10	S7694_048_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	048	0		29	10	S7694_048_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	049	0		29	10	S7694_049_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	049	0		29	10	S7694_049_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	049	0		29	10	S7694_049_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	049	0		29	10	S7694_049_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	049	0		29	10	S7694_049_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	049	0		29	10	S7694_049_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	049	0		29	10	S7694_049_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	049	0		29	10	S7694_049_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	050	0		29	10	S7694_050_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	050	0		29	10	S7694_050_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	050	0		29	10	S7694_050_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	050	0		29	10	S7694_050_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	050	0		29	10	S7694_050_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	050	0		29	10	S7694_050_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	050	0		29	10	S7694_050_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	050	0		29	10	S7694_050_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	051	0		29	10	S7694_051_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	051	0		29	10	S7694_051_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	051	0		29	10	S7694_051_0	6	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	051	0		29	10	S7694_051_0	6	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	051	0		29	10	S7694_051_0	6	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	051	0		29	10	S7694_051_0	6	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	051	0		29	10	S7694_051_0	6	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	051	0		29	10	S7694_051_0	6	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	052	0		29	10	S7694_052_0	6	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	052	0		29	10	S7694_052_0	6	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	052	0		29	10	S7694_052_0	6	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	052	0		29	10	S7694_052_0	6	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	052	0		29	10	S7694_052_0	6	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	052	0		29	10	S7694_052_0	6	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	052	0		29	10	S7694_052_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	052	0		29	10	S7694_052_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	053	0		29	10	S7694_053_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	053	0		29	10	S7694_053_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	053	0		29	10	S7694_053_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	053	0		29	10	S7694_053_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	053	0		29	10	S7694_053_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	053	0		29	10	S7694_053_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	053	0		29	10	S7694_053_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	053	0		29	10	S7694_053_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	054	0		29	10	S7694_054_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	054	0		29	10	S7694_054_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	054	0		29	10	S7694_054_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	054	0		29	10	S7694_054_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	054	0		29	10	S7694_054_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	054	0		29	10	S7694_054_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	054	0		29	10	S7694_054_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	054	0		29	10	S7694_054_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	055	0		29	10	S7694_055_0	6	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	055	0		29	10	S7694_055_0	6	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	055	0		29	10	S7694_055_0	6	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	055	0		29	10	S7694_055_0	6	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	055	0		29	10	S7694_055_0	6	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	055	0		29	10	S7694_055_0	6	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	055	0		29	10	S7694_055_0	6	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	055	0		29	10	S7694_055_0	6	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	056	0		29	10	S7694_056_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	056	0		29	10	S7694_056_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	056	0		29	10	S7694_056_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	056	0		29	10	S7694_056_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	056	0		29	10	S7694_056_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	056	0		29	10	S7694_056_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	056	0		29	10	S7694_056_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	056	0		29	10	S7694_056_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	057	0		29	10	S7694_057_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	057	0		29	10	S7694_057_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	057	0		29	10	S7694_057_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	057	0		29	10	S7694_057_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	057	0		29	10	S7694_057_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	057	0		29	10	S7694_057_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	057	0		29	10	S7694_057_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	057	0		29	10	S7694_057_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	058	0		29	10	S7694_058_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	058	0		29	10	S7694_058_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	058	0		29	10	S7694_058_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	058	0		29	10	S7694_058_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	058	0		29	10	S7694_058_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	058	0		29	10	S7694_058_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	058	0		29	10	S7694_058_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	058	0		29	10	S7694_058_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	059	0		29	10	S7694_059_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	059	0		29	10	S7694_059_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	059	0		29	10	S7694_059_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	059	0		29	10	S7694_059_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	059	0		29	10	S7694_059_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	059	0		29	10	S7694_059_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	059	0		29	10	S7694_059_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	059	0		29	10	S7694_059_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	060	0		29	10	S7694_060_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	060	0		29	10	S7694_060_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	060	0		29	10	S7694_060_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	060	0		29	10	S7694_060_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	060	0		29	10	S7694_060_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	060	0		29	10	S7694_060_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	060	0		29	10	S7694_060_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	060	0		29	10	S7694_060_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	061	0		29	10	S7694_061_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	061	0		29	10	S7694_061_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	061	0		29	10	S7694_061_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	061	0		29	10	S7694_061_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	061	0		29	10	S7694_061_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	061	0		29	10	S7694_061_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	061	0		29	10	S7694_061_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	061	0		29	10	S7694_061_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	062	0		29	10	S7694_062_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	062	0		29	10	S7694_062_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	062	0		29	10	S7694_062_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	062	0		29	10	S7694_062_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	062	0		29	10	S7694_062_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	062	0		29	10	S7694_062_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	062	0		29	10	S7694_062_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	062	0		29	10	S7694_062_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	063	0		29	10	S7694_063_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	063	0		29	10	S7694_063_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	063	0		29	10	S7694_063_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	063	0		29	10	S7694_063_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	063	0		29	10	S7694_063_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	063	0		29	10	S7694_063_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	063	0		29	10	S7694_063_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	063	0		29	10	S7694_063_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	064	0		29	10	S7694_064_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	064	0		29	10	S7694_064_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	064	0		29	10	S7694_064_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	064	0		29	10	S7694_064_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	064	0		29	10	S7694_064_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	064	0		29	10	S7694_064_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	064	0		29	10	S7694_064_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	064	0		29	10	S7694_064_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	065	0		29	10	S7694_065_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	065	0		29	10	S7694_065_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	065	0		29	10	S7694_065_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	065	0		29	10	S7694_065_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	065	0		29	10	S7694_065_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	065	0		29	10	S7694_065_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	065	0		29	10	S7694_065_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	065	0		29	10	S7694_065_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	066	0		29	10	S7694_066_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	066	0		29	10	S7694_066_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	066	0		29	10	S7694_066_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	066	0		29	10	S7694_066_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	066	0		29	10	S7694_066_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	066	0		29	10	S7694_066_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	066	0		29	10	S7694_066_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	066	0		29	10	S7694_066_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	067	0		29	10	S7694_067_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	067	0		29	10	S7694_067_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	067	0		29	10	S7694_067_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	067	0		29	10	S7694_067_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	067	0		29	10	S7694_067_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S7694	067	0		29	10	S7694_067_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	067	0		29	10	S7694_067_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	067	0		29	10	S7694_067_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	068	0		29	10	S7694_068_0	5	1	1	Tier 1	010000	3	2	Tier 1	000011011010001000000				30	90		30	90		30				90								Tier 1	2	2		000011011010001000000	Tier 1																						Tier 1				0.00	0.00		8.00	24.00		8.00				0.00									4
S7694	068	0		29	10	S7694_068_0	5	2	1	Tier 2	000001	3	2	Tier 2	000011011010001000000				30	90		30	90		30				90								Tier 2	2	2		000011011010001000000	Tier 2																						Tier 2				20.00	60.00		25.00	75.00		25.00				60.00									4
S7694	068	0		29	10	S7694_068_0	5	3	1	Tier 3	100000	1	2	Tier 3	000011011010001000000				30	90		30	90		30				90								Tier 3	2	2		000011011010001000000	Tier 3																						Tier 3				35.00	105.00		40.00	120.00		35.00				105.00									4
S7694	068	0		29	10	S7694_068_0	5	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S7694	068	0		29	10	S7694_068_0	5	2	3	Tier 2	000001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S7694	068	0		29	10	S7694_068_0	5	1	3	Tier 1	010000	3	2	Tier 1	000011000010001000000				30	90					30				90								Tier 1	2	2		000011000000001000000	Tier 1																						Tier 1				0.00	0.00									0.00								1	4
S7694	068	0		29	10	S7694_068_0	5	4	1	Tier 4	010010	1	1	Tier 4	000010010010000000000				30			30			30												Tier 4	2	1	000010010010000000000		Tier 4				25			25			25												Tier 4																							4
S7694	068	0		29	10	S7694_068_0	5	4	3	Tier 4	010010	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S8067	001	0		29	10	S8067_001_0	4	3	1	Tier 3 - High Cost Injectable	000010		1	Tier 3 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 3 - High Cost Injectable	2	4	011000000011001000000	011000000011001000000	Tier 3 - High Cost Injectable	25	25								25	25			25								Tier 3 - High Cost Injectable	100.00	250.00								100.00	250.00			250.00									3
S8067	001	0		29	10	S8067_001_0	4	2	1	Tier 2 - Formulary Brand	000001		2	Tier 2 - Formulary Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Formulary Brand	1	2		011000000011001000000	Tier 2 - Formulary Brand																						Tier 2 - Formulary Brand	30.00	75.00								30.00	75.00			75.00									3
S8067	001	0		29	10	S8067_001_0	4	1	1	Tier 1 - Generic	010000		2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									3
S8067	002	0		29	10	S8067_002_0	4	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	4	011000000011001000000	011000000011001000000	Tier 4 - High Cost Injectable	25	25								25	25			25								Tier 4 - High Cost Injectable	100.00	250.00								100.00	250.00			250.00									4
S8067	002	0		29	10	S8067_002_0	4	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	50.00	125.00								50.00	125.00			125.00									4
S8067	002	0		29	10	S8067_002_0	4	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	30.00	75.00								30.00	75.00			75.00									4
S8067	002	0		29	10	S8067_002_0	4	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
S8067	003	0		29	10	S8067_003_0	5	3	3	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand																							Tier 3 - Non-Preferred Brand					Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand																						2	4
S8067	003	0		29	10	S8067_003_0	5	2	3	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand																							Tier 2 - Preferred Brand					Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand																						2	4
S8067	003	0		29	10	S8067_003_0	5	1	3	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50								1	4
S8067	003	0		29	10	S8067_003_0	5	4	1	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable	011000000011001000000	34	90								34	90			90								Tier 4 - High Cost Injectable	2	2		011000000011001000000	Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable	40.00	100.00								40.00	100.00			100.00									4
S8067	003	0		29	10	S8067_003_0	5	3	1	Tier 3 - Non-Preferred Brand	100000	3	2	Tier 3 - Non-Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 3 - Non-Preferred Brand	2	2		011000000011001000000	Tier 3 - Non-Preferred Brand																						Tier 3 - Non-Preferred Brand	40.00	100.00								40.00	100.00			100.00									4
S8067	003	0		29	10	S8067_003_0	5	2	1	Tier 2 - Preferred Brand	000001	3	2	Tier 2 - Preferred Brand	011000000011001000000	34	90								34	90			90								Tier 2 - Preferred Brand	1	2		011000000011001000000	Tier 2 - Preferred Brand																						Tier 2 - Preferred Brand	20.00	50.00								20.00	50.00			50.00									4
S8067	003	0		29	10	S8067_003_0	5	4	3	Tier 4 - High Cost Injectable	000010	1	1	Tier 4 - High Cost Injectable																							Tier 4 - High Cost Injectable					Tier 4 - High Cost Injectable																						Tier 4 - High Cost Injectable																						2	4
S8067	003	0		29	10	S8067_003_0	5	1	1	Tier 1 - Generic	010000	3	2	Tier 1 - Generic	011000000011001000000	34	90								34	90			90								Tier 1 - Generic	2	2		011000000011001000000	Tier 1 - Generic																						Tier 1 - Generic	5.00	12.50								5.00	12.50			12.50									4
S8201	001	0		29	10	S8201_001_0	1	1	1	Generic	010000		2	Generic	011000000010001000000	31	90								31				90								Generic	2	2		011000000010001000000	Generic																						Generic	5.00	15.00								5.00				15.00									3
S8201	001	0		29	10	S8201_001_0	1	2	1	Preferred Brand	000001		2	Preferred Brand	011000000010001000000	31	90								31				90								Preferred Brand	2	2		011000000010001000000	Preferred Brand																						Preferred Brand	32.00	96.00								32.00				96.00									3
S8201	001	0		29	10	S8201_001_0	1	5	1	Specialty	010010		1	Specialty	010000000010010000000	31									31			31									Specialty	2	1	010000000010010000000		Specialty	25									25			25									Specialty																							3
S8201	001	0		29	10	S8201_001_0	1	4	1	Low Cost Injectables	010010		2	Low Cost Injectables	011000000010001000000	31	90								31				90								Low Cost Injectables	2	1	011000000010001000000		Low Cost Injectables	25	25								25				25								Low Cost Injectables																							3
S8201	001	0		29	10	S8201_001_0	1	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	011000000010001000000	31	90								31				90								Non-Preferred Brand	2	2		011000000010001000000	Non-Preferred Brand																						Non-Preferred Brand	64.00	192.00								64.00				192.00									3
S8277	001	0		29	10	S8277_001_0	2	3	1	Tier 3	000001		1	Tier 3	010000000010010010000	30									30			30			30						Tier 3	2	1	010000000010010010000		Tier 3	25									25			25			22						Tier 3																							2
S8277	001	0		29	10	S8277_001_0	2	1	1	Tier 1	010000		2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	15.00								5.00				15.00									2
S8277	001	0		29	10	S8277_001_0	2	2	1	Tier 2	000001		2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	21.00	63.00								21.00				63.00									2
S8277	002	0		29	10	S8277_002_0	2	2	3	Tier 2	000001	1	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S8277	002	0		29	10	S8277_002_0	2	3	3	Tier 3	100000	1	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S8277	002	0		29	10	S8277_002_0	2	4	3	Tier 4	000001	1	1	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S8277	002	0		29	10	S8277_002_0	2	4	1	Tier 4	000001	1	1	Tier 4	010000000010010010000	30									30			30			30						Tier 4	2	1	010000000010010010000		Tier 4	33									33			33			30						Tier 4																							4
S8277	002	0		29	10	S8277_002_0	2	3	1	Tier 3	100000	1	2	Tier 3	011000000010001000000	30	90								30				90								Tier 3	2	2		011000000010001000000	Tier 3																						Tier 3	55.00	110.00								55.00				110.00									4
S8277	002	0		29	10	S8277_002_0	2	2	1	Tier 2	000001	1	2	Tier 2	011000000010001000000	30	90								30				90								Tier 2	2	2		011000000010001000000	Tier 2																						Tier 2	30.00	60.00								30.00				60.00									4
S8277	002	0		29	10	S8277_002_0	2	1	1	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	10.00								5.00				10.00									4
S8277	002	0		29	10	S8277_002_0	2	1	3	Tier 1	010000	1	2	Tier 1	011000000010001000000	30	90								30				90								Tier 1	2	2		011000000010001000000	Tier 1																						Tier 1	5.00	10.00								5.00				10.00								1	4
S8475	001	0		29	10	S8475_001_0	1	4	1	Tier 4	100100		2	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							3
S8475	001	0		29	10	S8475_001_0	1	3	1	Tier 3	000110		2	Tier 3	010000000010010000000	30									30			30									Tier 3	2	2		010000000010010000000	Tier 3																						Tier 3	66.00									66.00			66.00										3
S8475	001	0		29	10	S8475_001_0	1	2	1	Tier 2	010001		2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00									3
S8475	001	0		29	10	S8475_001_0	1	1	1	Tier 1	001001		2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00									3
S8475	001	0		29	10	S8475_001_0	1	5	1	Tier 5	010010		1	Tier 5	010000000000100000000	30											7										Tier 5	1	1	010000000000100000000		Tier 5	33											33										Tier 5																							3
S8475	002	0		29	10	S8475_002_0	1	1	3	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00								1	4
S8475	002	0		29	10	S8475_002_0	1	2	3	Tier 2	010001	3	2	Tier 2																							Tier 2					Tier 2																						Tier 2																						2	4
S8475	002	0		29	10	S8475_002_0	1	3	3	Tier 3	000110	3	2	Tier 3																							Tier 3					Tier 3																						Tier 3																						2	4
S8475	002	0		29	10	S8475_002_0	1	4	3	Tier 4	100100	1	2	Tier 4																							Tier 4					Tier 4																						Tier 4																						2	4
S8475	002	0		29	10	S8475_002_0	1	5	1	Tier 5	010010	1	1	Tier 5	010000000000100000000	30											7										Tier 5	1	1	010000000000100000000		Tier 5	33											33										Tier 5																							4
S8475	002	0		29	10	S8475_002_0	1	4	1	Tier 4	100100	1	2	Tier 4	010000000010000000000	30									30												Tier 4	2	1	010000000010000000000		Tier 4	25									25												Tier 4																							4
S8475	002	0		29	10	S8475_002_0	1	5	3	Tier 5	010010	1	1	Tier 5																							Tier 5					Tier 5																						Tier 5																						2	4
S8475	002	0		29	10	S8475_002_0	1	2	1	Tier 2	010001	3	2	Tier 2	011000000011011000000	30	90								30	90		30	90								Tier 2	2	2		011000000011011000000	Tier 2																						Tier 2	20.00	60.00								20.00	60.00		20.00	40.00									4
S8475	002	0		29	10	S8475_002_0	1	1	1	Tier 1	001001	1	2	Tier 1	011000000011011000000	30	90								30	90		30	90								Tier 1	2	2		011000000011011000000	Tier 1																						Tier 1	0.00	0.00								0.00	0.00		0.00	0.00									4
S8475	002	0		29	10	S8475_002_0	1	3	1	Tier 3	000110	3	2	Tier 3	010000000010010000000	30									30			30									Tier 3	2	2		010000000010010000000	Tier 3																						Tier 3	66.00									66.00			66.00										4
S8841	001	0		29	10	S8841_001_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	001	0		29	10	S8841_001_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	001	0		29	10	S8841_001_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	001	0		29	10	S8841_001_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	002	0		29	10	S8841_002_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	002	0		29	10	S8841_002_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	002	0		29	10	S8841_002_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	12.00	12.00								12.00	12.00			12.00			12.00						3
S8841	002	0		29	10	S8841_002_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	003	0		29	10	S8841_003_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	003	0		29	10	S8841_003_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	003	0		29	10	S8841_003_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	003	0		29	10	S8841_003_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	004	0		29	10	S8841_004_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	004	0		29	10	S8841_004_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	004	0		29	10	S8841_004_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	004	0		29	10	S8841_004_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	005	0		29	10	S8841_005_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	005	0		29	10	S8841_005_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	005	0		29	10	S8841_005_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	005	0		29	10	S8841_005_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	006	0		29	10	S8841_006_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	006	0		29	10	S8841_006_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	006	0		29	10	S8841_006_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	006	0		29	10	S8841_006_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	007	0		29	10	S8841_007_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	007	0		29	10	S8841_007_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	007	0		29	10	S8841_007_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	007	0		29	10	S8841_007_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	008	0		29	10	S8841_008_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	008	0		29	10	S8841_008_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	008	0		29	10	S8841_008_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	008	0		29	10	S8841_008_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	009	0		29	10	S8841_009_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	009	0		29	10	S8841_009_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	54			54			54			54												Non-Preferred Brand																							3
S8841	009	0		29	10	S8841_009_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	009	0		29	10	S8841_009_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	010	0		29	10	S8841_010_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	010	0		29	10	S8841_010_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	54			54			54			54												Non-Preferred Brand																							3
S8841	010	0		29	10	S8841_010_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	010	0		29	10	S8841_010_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	011	0		29	10	S8841_011_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	011	0		29	10	S8841_011_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	011	0		29	10	S8841_011_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	011	0		29	10	S8841_011_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	012	0		29	10	S8841_012_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	012	0		29	10	S8841_012_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	54			54			54			54												Non-Preferred Brand																							3
S8841	012	0		29	10	S8841_012_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	012	0		29	10	S8841_012_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	013	0		29	10	S8841_013_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	013	0		29	10	S8841_013_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	013	0		29	10	S8841_013_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	013	0		29	10	S8841_013_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	014	0		29	10	S8841_014_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	014	0		29	10	S8841_014_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	014	0		29	10	S8841_014_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	014	0		29	10	S8841_014_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	015	0		29	10	S8841_015_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	015	0		29	10	S8841_015_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	015	0		29	10	S8841_015_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	015	0		29	10	S8841_015_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	016	0		29	10	S8841_016_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	15.00	10.00								15.00	10.00			10.00			10.00						3
S8841	016	0		29	10	S8841_016_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	016	0		29	10	S8841_016_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	016	0		29	10	S8841_016_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	017	0		29	10	S8841_017_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	12.00	12.00								12.00	12.00			12.00			12.00						3
S8841	017	0		29	10	S8841_017_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	017	0		29	10	S8841_017_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	017	0		29	10	S8841_017_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	018	0		29	10	S8841_018_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	018	0		29	10	S8841_018_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	018	0		29	10	S8841_018_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	018	0		29	10	S8841_018_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	019	0		29	10	S8841_019_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	019	0		29	10	S8841_019_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	019	0		29	10	S8841_019_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	019	0		29	10	S8841_019_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	020	0		29	10	S8841_020_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	020	0		29	10	S8841_020_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	020	0		29	10	S8841_020_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	020	0		29	10	S8841_020_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	021	0		29	10	S8841_021_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	021	0		29	10	S8841_021_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	54			54			54			54												Non-Preferred Brand																							3
S8841	021	0		29	10	S8841_021_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	021	0		29	10	S8841_021_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	022	0		29	10	S8841_022_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	022	0		29	10	S8841_022_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	022	0		29	10	S8841_022_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	022	0		29	10	S8841_022_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	023	0		29	10	S8841_023_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	023	0		29	10	S8841_023_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	023	0		29	10	S8841_023_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	023	0		29	10	S8841_023_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	024	0		29	10	S8841_024_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	024	0		29	10	S8841_024_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	024	0		29	10	S8841_024_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	024	0		29	10	S8841_024_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	025	0		29	10	S8841_025_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	12.00	12.00								12.00	12.00			12.00			12.00						3
S8841	025	0		29	10	S8841_025_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	025	0		29	10	S8841_025_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	025	0		29	10	S8841_025_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	026	0		29	10	S8841_026_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	30			30			30			30												Specialty																							3
S8841	026	0		29	10	S8841_026_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	49			49			49			49												Non-Preferred Brand																							3
S8841	026	0		29	10	S8841_026_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	25.00	9.00								25.00	9.00			9.00			9.00						3
S8841	026	0		29	10	S8841_026_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	027	0		29	10	S8841_027_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	12.00	12.00								12.00	12.00			12.00			12.00						3
S8841	027	0		29	10	S8841_027_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	027	0		29	10	S8841_027_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	027	0		29	10	S8841_027_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	028	0		29	10	S8841_028_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	028	0		29	10	S8841_028_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	028	0		29	10	S8841_028_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	028	0		29	10	S8841_028_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	17.00	8.00								17.00	8.00			8.00			8.00						3
S8841	029	0		29	10	S8841_029_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	029	0		29	10	S8841_029_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	029	0		29	10	S8841_029_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	029	0		29	10	S8841_029_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	12.00	12.00								12.00	12.00			12.00			12.00						3
S8841	030	0		29	10	S8841_030_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	53			53			53			53												Non-Preferred Brand																							3
S8841	030	0		29	10	S8841_030_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	030	0		29	10	S8841_030_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	16.00	9.00								16.00	9.00			9.00			9.00						3
S8841	030	0		29	10	S8841_030_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	031	0		29	10	S8841_031_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	031	0		29	10	S8841_031_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	031	0		29	10	S8841_031_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	031	0		29	10	S8841_031_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	032	0		29	10	S8841_032_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	52			52			52			52												Non-Preferred Brand																							3
S8841	032	0		29	10	S8841_032_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	032	0		29	10	S8841_032_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	18.00	10.00								18.00	10.00			10.00			10.00						3
S8841	032	0		29	10	S8841_032_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	033	0		29	10	S8841_033_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	19.00	10.00								19.00	10.00			10.00			10.00						3
S8841	033	0		29	10	S8841_033_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	033	0		29	10	S8841_033_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	52			52			52			52												Non-Preferred Brand																							3
S8841	033	0		29	10	S8841_033_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	034	0		29	10	S8841_034_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	11.00	11.00								11.00	11.00			11.00			11.00						3
S8841	034	0		29	10	S8841_034_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	034	0		29	10	S8841_034_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S8841	034	0		29	10	S8841_034_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	036	0		29	10	S8841_036_0	6	1	1	Generic	010000		2	Generic	011000000011001001000	30	90								30	90			90			90					Generic	2	2		011000000011001001000	Generic																						Generic	10.00	10.00								10.00	10.00			10.00			10.00						3
S8841	036	0		29	10	S8841_036_0	6	3	1	Non-Preferred Brand	100000		2	Non-Preferred Brand	010010010010000000000	30			30			30			30												Non-Preferred Brand	2	1	010010010010000000000		Non-Preferred Brand	55			55			55			55												Non-Preferred Brand																							3
S8841	036	0		29	10	S8841_036_0	6	2	1	Preferred Brand	000001		2	Preferred Brand	010010010010000000000	30			30			30			30												Preferred Brand	2	1	010010010010000000000		Preferred Brand	33			33			33			33												Preferred Brand																							3
S8841	036	0		29	10	S8841_036_0	6	4	1	Specialty	000001		1	Specialty	010010010010000000000	30			30			30			30												Specialty	2	1	010010010010000000000		Specialty	33			33			33			33												Specialty																							3
S9176	002	0		29	10	S9176_002_0	1	3	1	Tier 3 Formulary Brand	000010	1	2	Tier 3 Formulary Brand	011000000010011000000	30	90								30			30	90								Tier 3 Formulary Brand	2	2		011000000010011000000	Tier 3 Formulary Brand																						Tier 3 Formulary Brand	55.00	165.00								55.00			55.00	110.00									4
S9176	002	0		29	10	S9176_002_0	1	2	1	Tier 2 Formulary Preferred Brand	000001	1	2	Tier 2 Formulary Preferred Brand	011000000010011000000	30	90								30			30	90								Tier 2 Formulary Preferred Brand	2	2		011000000010011000000	Tier 2 Formulary Preferred Brand																						Tier 2 Formulary Preferred Brand	35.00	105.00								35.00			35.00	70.00									4
S9176	002	0		29	10	S9176_002_0	1	1	1	Tier 1 Formulary Generic	010000	1	2	Tier 1 Formulary Generic	011000000010011000000	30	90								30			30	90								Tier 1 Formulary Generic	2	2		011000000010011000000	Tier 1 Formulary Generic																						Tier 1 Formulary Generic	10.00	30.00								10.00			10.00	20.00									4
S9176	002	0		29	10	S9176_002_0	1	4	1	Tier 4 Formulary Specialty Brand	000010	1	1	Tier 4 Formulary Specialty Brand	010000000010010000000	30									30			30									Tier 4 Formulary Specialty Brand	2	1	010000000010010000000		Tier 4 Formulary Specialty Brand	25									25			25									Tier 4 Formulary Specialty Brand																							4
S9176	003	0		29	10	S9176_003_0	1	1	3	Tier 1 Formulary Generic	010000	1	2	Tier 1 Formulary Generic	011000000010011000000	30	90								30			30	90								Tier 1 Formulary Generic	2	2		011000000010011000000	Tier 1 Formulary Generic																						Tier 1 Formulary Generic	2.00	6.00								2.00			2.00	4.00								1	4
S9176	003	0		29	10	S9176_003_0	1	2	3	Tier 2 Formulary Preferred Brand	000001	1	2	Tier 2 Formulary Preferred Brand																							Tier 2 Formulary Preferred Brand					Tier 2 Formulary Preferred Brand																						Tier 2 Formulary Preferred Brand																						2	4
S9176	003	0		29	10	S9176_003_0	1	3	3	Tier 3 Formulary Brand	000010	1	2	Tier 3 Formulary Brand																							Tier 3 Formulary Brand					Tier 3 Formulary Brand																						Tier 3 Formulary Brand																						2	4
S9176	003	0		29	10	S9176_003_0	1	4	1	Tier 4 Formulary Brand Specialty	000010	1	1	Tier 4 Formulary Brand Specialty	010000000010010000000	30									30			30									Tier 4 Formulary Brand Specialty	2	1	010000000010010000000		Tier 4 Formulary Brand Specialty	25									25			25									Tier 4 Formulary Brand Specialty																							4
S9176	003	0		29	10	S9176_003_0	1	3	1	Tier 3 Formulary Brand	000010	1	2	Tier 3 Formulary Brand	011000000010011000000	30	90								30			30	90								Tier 3 Formulary Brand	2	2		011000000010011000000	Tier 3 Formulary Brand																						Tier 3 Formulary Brand	55.00	165.00								55.00			55.00	110.00									4
S9176	003	0		29	10	S9176_003_0	1	4	3	Tier 4 Formulary Brand Specialty	000010	1	1	Tier 4 Formulary Brand Specialty																							Tier 4 Formulary Brand Specialty					Tier 4 Formulary Brand Specialty																						Tier 4 Formulary Brand Specialty																						2	4
S9176	003	0		29	10	S9176_003_0	1	1	1	Tier 1 Formulary Generic	010000	1	2	Tier 1 Formulary Generic	011000000010011000000	30	90								30			30	90								Tier 1 Formulary Generic	2	2		011000000010011000000	Tier 1 Formulary Generic																						Tier 1 Formulary Generic	2.00	6.00								2.00			2.00	4.00									4
S9176	003	0		29	10	S9176_003_0	1	2	1	Tier 2 Formulary Preferred Brand	000001	1	2	Tier 2 Formulary Preferred Brand	011000000010011000000	30	90								30			30	90								Tier 2 Formulary Preferred Brand	2	2		011000000010011000000	Tier 2 Formulary Preferred Brand																						Tier 2 Formulary Preferred Brand	35.00	105.00								35.00			35.00	70.00									4
