pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	mrx_form_model_type	mrx_drug_ben_yn	mrx_benefit_type	mrx_partd_network_loc	mrx_nat_rx_cov_yn	mrx_ltc_attest_flag	mrx_floor_price_yn	mrx_first_fill	mrx_quantity_limits	mrx_auth_ynba	mrx_step_ther_drugs_yn	mrx_otc_meds_pay_ump_yn	mrx_otc_meds_attest_flag	mrx_otc_step_therapy_yn	mrx_formulary_tiers_num	mrx_tier_form_ex	mrx_form_tier_model_2	mrx_form_tier_model_3	mrx_form_tier_model_4	mrx_form_tier_model_5	mrx_form_tier_model_5_opt1	mrx_form_tier_model_5_opt2	mrx_form_tier_model_5_opt3	mrx_form_tier_model_5_opt4	mrx_form_tier_model_5_opt5	mrx_form_tier_model_5_opt6	mrx_form_tier_model_6	mrx_form_tier_model_6_opt1	mrx_form_tier_model_6_opt2	mrx_form_tier_model_6_opt3	mrx_form_tier_model_6_opt4	mrx_form_tier_model_6_opt5	mrx_form_tier_model_2_mmp	mrx_form_tier_model_3_mmp	mrx_form_tier_model_4_mmp	mrx_form_tier_model_5_mmp	mrx_form_tier_model_6_mmp	mrx_ae_oon_cstshr_struct	mrx_ae_cstshr_apply	mrx_form_model_desc	mrx_ae_ooptcs_apply	mrx_alt_ded_charge	mrx_alt_ded_amount	mrx_alt_ded_type_yn	mrx_alt_no_ded_tier	mrx_alt_ded_tier_cstshr_yn	mrx_alt_gen_cstshr_struct	mrx_alt_gen_coins_pct	mrx_alt_gen_copay_amt	mrx_alt_oon_cstshr_struct	mrx_alt_red_cost_sharing	mrx_alt_red_cost_sharing_items	mrx_alt_excl_drugs_yn	mrx_alt_excl_drugs_maxplan_yn	mrx_alt_excl_max_plan_amt	mrx_alt_gap_covg_yn	mrx_alt_pre_icl_cost_share	mrx_alt_pre_icl_exclud_only_yn	mrx_alt_pre_icl_cost_share_mmp	mrx_alt_pre_icl_lis_mmp_yn	mrx_alt_pre_icl_lis_mmp_tiers	mrx_alt_max_enroll_mmp_yn	mrx_alt_max_enroll_mmp_amt	mrx_alt_cov_lmt_yn	mrx_alt_cov_lmt_amt	mrx_alt_gap_covg_tier	mrx_alt_cstshr_post_oopt	mrx_post_exclud_only_yn	mrx_alt_cstshr_post_oopt_mmp	mrx_gen_loc_in	mrx_gen_in_1m	mrx_gen_in_2m	mrx_gen_in_3m	mrx_gen_loc_inp	mrx_gen_inp_1m	mrx_gen_inp_2m	mrx_gen_inp_3m	mrx_gen_loc_oon	mrx_gen_oon_1m	mrx_gen_oon_os	mrx_gen_loc_mo	mrx_gen_mo_1m	mrx_gen_mo_2m	mrx_gen_mo_3m	mrx_gen_loc_mop	mrx_gen_mop_1m	mrx_gen_mop_2m	mrx_gen_mop_3m	mrx_gen_loc_ltc	mrx_gen_ltc_1m	mrx_tier_extd_days_gen_yn
H0022	001	0	1	48	05	H0022_001_0	4	MM_3A	1	4	110110	1	1		2	1	1	2	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	1	001100	2		3		011100			2																						
H0028	001	0	1	01	01	H0028_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H0028	002	0	1	01	01	H0028_002_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H0028	003	0	1	01	01	H0028_003_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H0028	004	0	1	01	01	H0028_004_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0028	005	0	1	01	01	H0028_005_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H0028	801	0	1	01	01	H0028_801_0	3		1																																																																																									
H0028	802	0	1	01	01	H0028_802_0	3		2																																																																																									
H0028	803	0	1	01	01	H0028_803_0	2		1																																																																																									
H0084	001	0	1	04	01	H0084_001_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0084	004	0	1	04	01	H0084_004_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0084	014	0	1	04	01	H0084_014_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0084	035	0	1	04	01	H0084_035_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0084	064	0	1	04	01	H0084_064_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0084	065	0	1	04	01	H0084_065_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0104	010	1	1	04	01	H0104_010_1	4	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0104	010	2	1	04	01	H0104_010_2	4	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0104	010	3	1	04	01	H0104_010_3	4	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0104	010	4	1	04	01	H0104_010_4	4	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0104	010	5	1	04	01	H0104_010_5	4	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0104	011	1	1	04	01	H0104_011_1	4	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011000	1				2							3							1			2																								
H0104	011	2	1	04	01	H0104_011_2	4	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011000	1				2							3							1			2																								
H0104	011	3	1	04	01	H0104_011_3	4	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011000	1				2							3							1			2																								
H0104	011	4	1	04	01	H0104_011_4	4	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011000	1				2							3							1			2																								
H0104	011	5	1	04	01	H0104_011_5	4	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011000	1				2							3							1			2																								
H0104	011	6	1	04	01	H0104_011_6	5	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011000	1				2							3							1			2																								
H0104	801	0	1	04	01	H0104_801_0	4		2																																																																																									
H0104	802	0	1	04	01	H0104_802_0	3		1																																																																																									
H0104	804	0	1	04	01	H0104_804_0	3		1																																																																																									
H0105	001	0	1	20	08	H0105_001_0	1		1																																																																																									
H0105	002	0	1	20	08	H0105_002_0	1		1																																																																																									
H0107	001	0	1	04	01	H0107_001_0	10	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H0107	002	0	1	04	01	H0107_002_0	11	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H0107	801	0	1	04	01	H0107_801_0	6		1																																																																																									
H0107	802	0	1	04	01	H0107_802_0	2		1																																																																																									
H0108	004	0	1	01	01	H0108_004_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	005	0	1	01	01	H0108_005_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	006	0	1	01	01	H0108_006_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	008	0	1	01	01	H0108_008_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	009	0	1	02	01	H0108_009_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	010	0	1	01	01	H0108_010_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	011	0	1	01	01	H0108_011_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	013	0	1	01	01	H0108_013_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	021	0	1	01	01	H0108_021_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	022	0	1	01	01	H0108_022_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	023	0	1	01	01	H0108_023_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	024	0	1	01	01	H0108_024_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	025	0	1	01	01	H0108_025_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	026	0	1	01	01	H0108_026_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	027	0	1	01	01	H0108_027_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	028	0	1	01	01	H0108_028_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	029	0	1	01	01	H0108_029_0	3		2																																																																																									
H0108	034	0	1	01	01	H0108_034_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	035	0	1	01	01	H0108_035_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	036	0	1	01	01	H0108_036_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	037	0	1	01	01	H0108_037_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	038	0	1	01	01	H0108_038_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	039	0	1	01	01	H0108_039_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	265.00	2	011000	1				2							3							1			2																								
H0108	040	0	1	01	01	H0108_040_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H0108	041	0	1	01	01	H0108_041_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H0108	042	0	1	01	01	H0108_042_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H0108	043	0	1	01	01	H0108_043_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H0108	044	0	1	01	01	H0108_044_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H0108	045	0	1	01	01	H0108_045_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	046	0	1	01	01	H0108_046_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0108	801	0	1	01	01	H0108_801_0	4		1																																																																																									
H0108	802	0	1	01	01	H0108_802_0	2		2																																																																																									
H0108	803	0	1	01	01	H0108_803_0	2		1																																																																																									
H0112	001	0	1	20	08	H0112_001_0	1		1																																																																																									
H0112	002	0	1	20	08	H0112_002_0	1		1																																																																																									
H0117	005	0	1	01	01	H0117_005_0	7	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0117	007	0	1	01	01	H0117_007_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H0137	001	0	1	48	05	H0137_001_0	2	MM_6A	1	4	110110	1	1		2	1	1	1	2			6	2																					1			Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs		3								3	1	1111				1			1			2		3		111111			1																						
H0141	001	0	1	01	01	H0141_001_0	13	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H0141	002	0	1	01	01	H0141_002_0	11	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H0147	001	0	1	48	05	H0147_001_0	8	MM_5F	1	4	110110	1	1		2	1	1	1	2			5	2																				6				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Brand Drugs		3								3	1	1111				1			2	1	001000	2		3		011111			1																						
H0148	001	0	1	48	05	H0148_001_0	5	MM_3A	1	4	110110	1	1		2	1	1	1	1	1	1	3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								3	1	1111				1			2	1	011000	2		3		011100			1																						
H0148	002	0	1	48	05	H0148_002_0	1	MM_3A	1	4	110110	1	1		2	1	1	1	1	1	1	3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								3	1	1111				1			2	1	011000	2		3		011100			1																						
H0150	001	0	1	01	01	H0150_001_0	3	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H0150	007	0	1	01	01	H0150_007_0	3		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H0150	012	0	1	01	01	H0150_012_0	1		2																																																																																									
H0150	804	0	1	01	01	H0150_804_0	1		1																																																																																									
H0150	808	0	1	02	01	H0150_808_0	1		1																																																																																									
H0150	809	0	1	01	01	H0150_809_0	1		2																																																																																									
H0150	810	0	1	01	01	H0150_810_0	1		1																																																																																									
H0150	811	0	1	02	01	H0150_811_0	1		2																																																																																									
H0150	812	0	1	02	01	H0150_812_0	1		1																																																																																									
H0151	001	0	1	01	01	H0151_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0151	015	0	1	01	01	H0151_015_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0151	025	0	1	01	01	H0151_025_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0151	801	0	1	01	01	H0151_801_0	1		1																																																																																									
H0151	804	0	1	01	01	H0151_804_0	1		1																																																																																									
H0151	805	0	1	01	01	H0151_805_0	1		2																																																																																									
H0154	001	0	1	01	01	H0154_001_0	5	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	125.00	1						2	1	0110	2			2	3							1			2																								
H0154	008	0	1	01	01	H0154_008_0	4		2																																																																																									
H0154	011	0	1	01	01	H0154_011_0	7	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H0154	012	0	1	01	01	H0154_012_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H0154	014	0	1	01	01	H0154_014_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0154	801	0	1	01	01	H0154_801_0	2		1																																																																																									
H0154	802	0	1	01	01	H0154_802_0	2		2																																																																																									
H0154	803	0	1	01	01	H0154_803_0	2		1																																																																																									
H0216	001	0	1	20	08	H0216_001_0	1		1																																																																																									
H0216	002	0	1	20	08	H0216_002_0	1		1																																																																																									
H0248	001	0	1	04	01	H0248_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	275.00	2	011000	1				2	1	0110	2			1	3							1		011111	2																								
H0251	002	0	1	01	01	H0251_002_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0281	001	0	1	48	05	H0281_001_0	8	MM_3A	1	4	110110	1	1		2	1	1	2	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	1	001000	2		3		011100			2																						
H0294	002	0	1	04	01	H0294_002_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0294	004	0	1	04	01	H0294_004_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0294	006	0	1	04	01	H0294_006_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0302	001	0	1	01	01	H0302_001_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0101	2			1	3							2	3200.00	010000	2																								
H0302	006	0	1	01	01	H0302_006_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
H0302	007	0	1	01	01	H0302_007_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0101	2			1	3							2	3200.00	010000	2																								
H0303	013	0	1	01	01	H0303_013_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0303	015	0	1	01	01	H0303_015_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0303	801	0	1	01	01	H0303_801_0	2		2																																																																																									
H0303	804	0	1	01	01	H0303_804_0	2		1																																																																																									
H0303	805	0	1	01	01	H0303_805_0	2		1																																																																																									
H0316	002	0	1	02	01	H0316_002_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0316	014	0	1	01	01	H0316_014_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0316	801	0	1	01	01	H0316_801_0	2		1																																																																																									
H0316	804	0	1	01	01	H0316_804_0	2		1																																																																																									
H0316	806	0	1	01	01	H0316_806_0	2		2																																																																																									
H0317	001	0	1	04	01	H0317_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0317	004	0	1	04	01	H0317_004_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0317	006	0	1	04	01	H0317_006_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0317	007	0	1	04	01	H0317_007_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H0318	002	0	1	01	01	H0318_002_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H0318	801	0	1	01	01	H0318_801_0	1		2																																																																																									
H0318	802	0	1	01	01	H0318_802_0	1		1																																																																																									
H0319	001	0	1	04	01	H0319_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0320	006	0	1	01	01	H0320_006_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0320	008	0	1	01	01	H0320_008_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0320	009	0	1	01	01	H0320_009_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0321	002	0	1	01	01	H0321_002_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0332	001	0	1	01	01	H0332_001_0	4		2																																																																																									
H0332	002	0	1	01	01	H0332_002_0	8	5A	1	4	101100	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	50.00	1						2	1	0110	2			1	3							1		010000	2																								
H0332	003	0	1	02	01	H0332_003_0	4		2																																																																																									
H0332	004	0	1	02	01	H0332_004_0	9	5A	1	4	101100	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	50.00	1						2	1	0110	2			1	3							1		010000	2																								
H0332	006	0	1	01	01	H0332_006_0	7	5A	1	4	101100	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	50.00	1						2	1	0110	2			1	3							1		010000	2																								
H0332	801	0	1	01	01	H0332_801_0	6		2																																																																																									
H0332	803	0	1	01	01	H0332_803_0	5		1																																																																																									
H0332	804	0	1	01	01	H0332_804_0	5		2																																																																																									
H0332	805	0	1	01	01	H0332_805_0	5		1																																																																																									
H0332	806	0	1	01	01	H0332_806_0	5		2																																																																																									
H0332	807	0	1	01	01	H0332_807_0	5		1																																																																																									
H0332	808	0	1	01	01	H0332_808_0	5		2																																																																																									
H0332	809	0	1	01	01	H0332_809_0	5		1																																																																																									
H0332	810	0	1	01	01	H0332_810_0	5		1																																																																																									
H0332	811	0	1	01	01	H0332_811_0	5		1																																																																																									
H0332	812	0	1	01	01	H0332_812_0	5		1																																																																																									
H0336	001	0	1	48	05	H0336_001_0	8	MM_4A	1	4	110110	1	1		2	1	1	1	2			4	2																			1					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011110			1																						
H0351	029	0	1	01	01	H0351_029_0	6	5A7	1	2	110101	1	1	2		1	1	1	2			6	4											1	9										1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
H0351	030	0	1	01	01	H0351_030_0	3		2																																																																																									
H0351	035	0	1	01	01	H0351_035_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0351	036	0	1	01	01	H0351_036_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0351	038	0	1	01	01	H0351_038_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0351	040	0	1	01	01	H0351_040_0	7	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0351	041	0	1	01	01	H0351_041_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0351	042	0	1	01	01	H0351_042_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0351	043	1	1	01	01	H0351_043_1	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0351	043	2	1	01	01	H0351_043_2	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0351	043	3	1	01	01	H0351_043_3	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0351	801	0	1	01	01	H0351_801_0	2		1																																																																																									
H0351	803	0	1	01	01	H0351_803_0	2		2																																																																																									
H0351	804	0	1	01	01	H0351_804_0	2		1																																																																																									
H0354	001	0	1	01	01	H0354_001_0	9	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H0354	021	0	1	01	01	H0354_021_0	7	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H0354	801	0	1	01	01	H0354_801_0	2		2																																																																																									
H0354	804	0	1	01	01	H0354_804_0	2		1																																																																																									
H0354	805	0	1	01	01	H0354_805_0	2		1																																																																																									
H0390	001	0	1	20	08	H0390_001_0	1		1																																																																																									
H0390	002	0	1	20	08	H0390_002_0	1		1																																																																																									
H0408	002	0	1	02	01	H0408_002_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0423	001	0	1	01	01	H0423_001_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	34	2
H0423	002	0	1	01	01	H0423_002_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	34	2
H0423	003	0	1	01	01	H0423_003_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	34	2
H0423	004	0	1	01	01	H0423_004_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	34	2
H0435	001	0	1	01	01	H0435_001_0	6		2																																																																																									
H0435	002	0	1	01	01	H0435_002_0	7	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		2	150.00	2	011010	1				2	1	0110	2			2	3							1			2																								
H0435	003	0	1	01	01	H0435_003_0	7	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0439	001	0	1	01	01	H0439_001_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H0439	801	0	1	01	01	H0439_801_0	2		1																																																																																									
H0439	802	0	1	02	01	H0439_802_0	2		1																																																																																									
H0439	803	0	1	01	01	H0439_803_0	2		1																																																																																									
H0439	804	0	1	02	01	H0439_804_0	2		1																																																																																									
H0439	805	0	1	01	01	H0439_805_0	2		2																																																																																									
H0439	806	0	1	02	01	H0439_806_0	2		2																																																																																									
H0477	001	0	1	20	08	H0477_001_0	1		1																																																																																									
H0477	002	0	1	20	08	H0477_002_0	1		1																																																																																									
H0490	004	0	1	01	01	H0490_004_0	10	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H0504	015	0	1	01	01	H0504_015_0	7	5B8	1	4	101110	1	1	1	2	1	1	1	2			6	5											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H0504	017	0	1	01	01	H0504_017_0	7	5E	1	4	101110	1	1	1	2	1	1	1	2			5	4				11																				Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H0504	021	0	1	01	01	H0504_021_0	7	5E	1	4	101110	1	1	1	2	1	1	1	2			5	4				11																				Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H0504	026	0	1	01	01	H0504_026_0	7	5E	1	4	101110	1	1	1	2	1	1	1	2			5	4				11																				Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H0504	027	0	1	01	01	H0504_027_0	7	5E	1	4	101110	1	1	1	2	1	1	1	2			5	4				11																				Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H0504	028	0	1	01	01	H0504_028_0	6	5E	1	4	101110	1	1	1	2	1	1	1	2			5	4				11																				Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H0504	029	0	1	01	01	H0504_029_0	6	5E	1	4	101110	1	1	1	2	1	1	1	2			5	4				11																				Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H0504	030	0	1	01	01	H0504_030_0	7	5E	1	4	101110	1	1	1	2	1	1	1	2			5	4				11																				Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H0504	031	0	1	01	01	H0504_031_0	7	5E	1	4	101110	1	1	1	2	1	1	1	2			5	4				11																				Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H0504	032	0	1	01	01	H0504_032_0	7	5E	1	4	101110	1	1	1	2	1	1	1	2			5	4				11																				Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H0504	803	0	1	01	01	H0504_803_0	3		1																																																																																									
H0504	804	0	1	01	01	H0504_804_0	2		1																																																																																									
H0504	805	0	1	01	01	H0504_805_0	2		2																																																																																									
H0523	002	0	1	01	01	H0523_002_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H0523	022	0	1	01	01	H0523_022_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H0523	031	0	1	01	01	H0523_031_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H0523	032	0	1	01	01	H0523_032_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H0523	052	0	1	01	01	H0523_052_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H0523	060	0	1	01	01	H0523_060_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		010001	2																								
H0523	801	0	1	01	01	H0523_801_0	1		2																																																																																									
H0523	805	0	1	01	01	H0523_805_0	1		1																																																																																									
H0524	002	0	2	01	01	H0524_002_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	003	0	1	01	01	H0524_003_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	008	0	1	01	01	H0524_008_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	010	0	2	01	01	H0524_010_0	7	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	013	0	1	01	01	H0524_013_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	015	0	1	01	01	H0524_015_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	029	0	1	01	01	H0524_029_0	6	5A5	1	3	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1							3							1			3																								
H0524	030	0	1	01	01	H0524_030_0	7	5A5	1	3	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1							3							1			3																								
H0524	031	0	1	01	01	H0524_031_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	032	0	1	01	01	H0524_032_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	033	0	1	01	01	H0524_033_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	034	0	1	01	01	H0524_034_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	035	0	1	01	01	H0524_035_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	036	0	1	01	01	H0524_036_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	037	0	1	01	01	H0524_037_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	038	0	1	01	01	H0524_038_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	039	0	1	01	01	H0524_039_0	3	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	040	0	1	01	01	H0524_040_0	6	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	041	0	1	01	01	H0524_041_0	6	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	042	0	1	01	01	H0524_042_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	043	0	1	01	01	H0524_043_0	4	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	046	0	1	01	01	H0524_046_0	4	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0524	801	0	1	01	01	H0524_801_0	1		2																																																																																									
H0524	802	0	1	01	01	H0524_802_0	1		2																																																																																									
H0524	803	0	2	01	01	H0524_803_0	1		2																																																																																									
H0524	804	0	2	01	01	H0524_804_0	1		2																																																																																									
H0524	805	0	1	01	01	H0524_805_0	1		1																																																																																									
H0524	806	0	1	01	01	H0524_806_0	1		1																																																																																									
H0524	807	0	2	01	01	H0524_807_0	1		1																																																																																									
H0524	808	0	2	01	01	H0524_808_0	1		1																																																																																									
H0524	809	0	1	01	01	H0524_809_0	1		1																																																																																									
H0524	810	0	1	01	01	H0524_810_0	1		1																																																																																									
H0524	811	0	2	01	01	H0524_811_0	1		1																																																																																									
H0524	812	0	2	01	01	H0524_812_0	1		1																																																																																									
H0542	001	0	1	20	08	H0542_001_0	1		1																																																																																									
H0542	002	0	1	20	08	H0542_002_0	1		1																																																																																									
H0543	001	0	1	01	01	H0543_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0543	004	0	1	01	01	H0543_004_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	007	0	1	01	01	H0543_007_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0543	013	0	1	01	01	H0543_013_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0543	019	0	1	01	01	H0543_019_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	022	0	1	01	01	H0543_022_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	028	0	1	01	01	H0543_028_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	029	0	1	01	01	H0543_029_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H0543	032	0	1	01	01	H0543_032_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	035	0	1	01	01	H0543_035_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	036	0	1	01	01	H0543_036_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	060	0	1	01	01	H0543_060_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0543	070	0	1	01	01	H0543_070_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H0543	086	0	1	01	01	H0543_086_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H0543	089	0	1	01	01	H0543_089_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H0543	121	0	1	01	01	H0543_121_0	3		2																																																																																									
H0543	138	0	1	01	01	H0543_138_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0543	140	0	1	01	01	H0543_140_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	144	0	1	01	01	H0543_144_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0543	145	0	1	01	01	H0543_145_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0543	146	0	1	01	01	H0543_146_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	147	0	1	01	01	H0543_147_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	148	0	1	01	01	H0543_148_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	149	0	1	01	01	H0543_149_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0543	151	0	1	01	01	H0543_151_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0543	152	0	1	01	01	H0543_152_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0543	153	0	1	01	01	H0543_153_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0543	802	0	1	01	01	H0543_802_0	2		2																																																																																									
H0543	805	0	1	01	01	H0543_805_0	2		1																																																																																									
H0543	806	0	1	01	01	H0543_806_0	2		1																																																																																									
H0544	002	0	1	01	01	H0544_002_0	10	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	003	0	1	01	01	H0544_003_0	8	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1		2	111000	1				2	1	0010	2			1	3							1		111000	2																								
H0544	004	0	1	01	01	H0544_004_0	9	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	005	0	1	01	01	H0544_005_0	8	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	007	0	1	01	01	H0544_007_0	9	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H0544	008	0	1	01	01	H0544_008_0	10	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H0544	010	0	1	01	01	H0544_010_0	10	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	012	0	1	01	01	H0544_012_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H0544	013	0	1	01	01	H0544_013_0	9	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	014	0	1	01	01	H0544_014_0	9	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	015	0	1	01	01	H0544_015_0	10	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	019	0	1	01	01	H0544_019_0	10	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	020	0	1	01	01	H0544_020_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	021	0	1	01	01	H0544_021_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H0544	024	0	1	01	01	H0544_024_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	025	0	1	01	01	H0544_025_0	8	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	027	0	1	01	01	H0544_027_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H0544	031	0	1	01	01	H0544_031_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	032	0	1	01	01	H0544_032_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	036	0	1	01	01	H0544_036_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	037	0	1	01	01	H0544_037_0	11	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	038	0	1	01	01	H0544_038_0	11	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H0544	041	0	1	01	01	H0544_041_0	12	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1		2	111000	1				2	1	0010	2			1	3							1		111000	2																								
H0544	801	0	1	01	01	H0544_801_0	6		2																																																																																									
H0544	802	0	1	01	01	H0544_802_0	6		1																																																																																									
H0544	804	0	1	01	01	H0544_804_0	4		1																																																																																									
H0545	001	0	1	01	01	H0545_001_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H0545	011	0	1	01	01	H0545_011_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H0545	012	0	1	01	01	H0545_012_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H0545	013	0	1	01	01	H0545_013_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H0545	801	0	1	01	01	H0545_801_0	2		1																																																																																									
H0545	802	0	1	01	01	H0545_802_0	2		1																																																																																									
H0562	009	0	1	01	01	H0562_009_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	012	0	1	01	01	H0562_012_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	039	0	1	01	01	H0562_039_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	040	0	1	01	01	H0562_040_0	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	044	0	1	01	01	H0562_044_0	1		2																																																																																									
H0562	045	0	1	01	01	H0562_045_0	2		2																																																																																									
H0562	053	0	1	01	01	H0562_053_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	055	0	1	01	01	H0562_055_0	4	5A7	1	2	110101	1	1	2		1	1	1	2			6	4											1	9										1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
H0562	068	0	1	01	01	H0562_068_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	070	0	1	01	01	H0562_070_0	5	5A7	1	2	110101	1	1	2		1	1	1	2			6	4											1	9										1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
H0562	079	0	1	01	01	H0562_079_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	084	0	1	01	01	H0562_084_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	087	0	1	01	01	H0562_087_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	089	0	1	01	01	H0562_089_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	090	0	1	01	01	H0562_090_0	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	091	0	1	01	01	H0562_091_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	092	0	1	01	01	H0562_092_0	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	093	0	1	01	01	H0562_093_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	094	0	1	01	01	H0562_094_0	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	095	0	1	01	01	H0562_095_0	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	096	0	1	01	01	H0562_096_0	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	097	0	1	01	01	H0562_097_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	098	1	1	01	01	H0562_098_1	3	5A7	1	3	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1							3							1			2																								
H0562	098	2	1	01	01	H0562_098_2	3	5A7	1	3	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1							3							1			2																								
H0562	099	1	1	01	01	H0562_099_1	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	099	2	1	01	01	H0562_099_2	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	100	1	1	01	01	H0562_100_1	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	100	2	1	01	01	H0562_100_2	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	101	1	1	01	01	H0562_101_1	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	101	2	1	01	01	H0562_101_2	3	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			1	3							1		111000	2																								
H0562	102	0	1	01	01	H0562_102_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	103	0	1	01	01	H0562_103_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H0562	801	0	1	01	01	H0562_801_0	1		1																																																																																									
H0562	803	0	1	01	01	H0562_803_0	1		2																																																																																									
H0562	804	0	1	01	01	H0562_804_0	1		1																																																																																									
H0564	006	0	1	01	01	H0564_006_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H0564	047	0	1	01	01	H0564_047_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H0564	052	0	1	01	01	H0564_052_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	120.00	2	110001	1				2							3							1			2																								
H0564	054	0	1	01	01	H0564_054_0	8	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H0564	801	0	1	01	01	H0564_801_0	4		1																																																																																									
H0564	810	0	1	01	01	H0564_810_0	3		2																																																																																									
H0564	811	0	1	01	01	H0564_811_0	3		1																																																																																									
H0571	001	0	1	01	01	H0571_001_0	6	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			2	3							1			2																								
H0571	005	0	1	01	01	H0571_005_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		100			90					1	31	1
H0602	001	0	1	18	06	H0602_001_0	8		2																																																																																									
H0602	003	0	1	18	06	H0602_003_0	7		2																																																																																									
H0602	007	0	1	18	06	H0602_007_0	7		2																																																																																									
H0602	009	0	1	18	06	H0602_009_0	7		2																																																																																									
H0602	017	0	1	18	06	H0602_017_0	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0602	019	0	1	18	06	H0602_019_0	6	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0602	020	0	1	18	06	H0602_020_0	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0602	022	0	1	18	06	H0602_022_0	6	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0602	026	0	1	18	06	H0602_026_0	5		2																																																																																									
H0602	027	0	1	18	06	H0602_027_0	5		2																																																																																									
H0602	039	0	1	18	06	H0602_039_0	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	75.00	2	011000	1				2	1	0110	2			2	3							1			2																								
H0602	040	0	2	18	06	H0602_040_0	3		2																																																																																									
H0602	041	0	2	18	06	H0602_041_0	4		2																																																																																									
H0602	042	0	1	18	06	H0602_042_0	6		2																																																																																									
H0602	043	0	1	18	06	H0602_043_0	6	5A	1	3	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	120.00	2	011000	1				2							3							1			2																								
H0602	801	0		18	06	H0602_801_0	4		1																																																																																									
H0609	002	0	1	01	01	H0609_002_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0609	007	0	1	01	01	H0609_007_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0609	012	0	1	01	01	H0609_012_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0609	015	0	1	01	01	H0609_015_0	2		2																																																																																									
H0609	018	0	1	01	01	H0609_018_0	2		2																																																																																									
H0609	020	0	1	01	01	H0609_020_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0609	801	0	1	01	01	H0609_801_0	2		2																																																																																									
H0609	804	0	1	01	01	H0609_804_0	2		1																																																																																									
H0609	805	0	1	01	01	H0609_805_0	2		1																																																																																									
H0609	806	0	2	01	01	H0609_806_0	2		1																																																																																									
H0613	001	0	1	20	08	H0613_001_0	1		1																																																																																									
H0613	003	0	1	20	08	H0613_003_0	1		1																																																																																									
H0620	002	0	1	04	01	H0620_002_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0621	006	0	1	01	01	H0621_006_0	10	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1							3							1			2																								
H0621	010	0	1	01	01	H0621_010_0	8	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1							3							1			2																								
H0624	001	0	1	01	01	H0624_001_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0630	013	0	1	01	01	H0630_013_0	6	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0630	014	0	1	01	01	H0630_014_0	5		1	1	110110	2	1	2		2	1	2	2																																																										110	30		90					01	30		110	30		90					1	31	2
H0630	015	0	1	01	01	H0630_015_0	6	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0630	016	0	1	01	01	H0630_016_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0630	017	0	1	01	01	H0630_017_0	7	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0630	018	0	1	01	01	H0630_018_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0630	019	0	1	02	01	H0630_019_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0630	020	0	1	01	01	H0630_020_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0630	021	0	1	01	01	H0630_021_0	5	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H0630	805	0	2	01	01	H0630_805_0	3		1																																																																																									
H0630	806	0	2	01	01	H0630_806_0	3		2																																																																																									
H0630	807	0	1	01	01	H0630_807_0	3		1																																																																																									
H0630	808	0	1	01	01	H0630_808_0	3		2																																																																																									
H0630	809	0	2	01	01	H0630_809_0	3		1																																																																																									
H0630	810	0	1	01	01	H0630_810_0	3		1																																																																																									
H0630	811	0	2	01	01	H0630_811_0	3		1																																																																																									
H0630	812	0	2	01	01	H0630_812_0	3		2																																																																																									
H0630	813	0	1	01	01	H0630_813_0	3		1																																																																																									
H0630	814	0	1	01	01	H0630_814_0	3		2																																																																																									
H0630	815	0	2	01	01	H0630_815_0	3		1																																																																																									
H0630	816	0	1	01	01	H0630_816_0	3		1																																																																																									
H0630	817	0	2	01	01	H0630_817_0	3		1																																																																																									
H0630	818	0	2	01	01	H0630_818_0	3		2																																																																																									
H0630	819	0	1	01	01	H0630_819_0	3		1																																																																																									
H0630	820	0	1	01	01	H0630_820_0	3		2																																																																																									
H0630	821	0	2	01	01	H0630_821_0	3		1																																																																																									
H0630	822	0	1	01	01	H0630_822_0	3		1																																																																																									
H0657	005	0	1	18	06	H0657_005_0	4		2																																																																																									
H0657	006	0	1	18	06	H0657_006_0	4		2																																																																																									
H0657	007	0	1	18	06	H0657_007_0	4		2																																																																																									
H0657	008	0	1	18	06	H0657_008_0	4		2																																																																																									
H0657	009	0	1	18	06	H0657_009_0	4		2																																																																																									
H0657	010	0	1	18	06	H0657_010_0	3		2																																																																																									
H0710	001	0	1	04	01	H0710_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H0712	001	0	1	02	01	H0712_001_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0712	005	0	1	01	01	H0712_005_0	3	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H0712	019	0	1	01	01	H0712_019_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0712	020	0	1	01	01	H0712_020_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H0755	030	0	1	01	01	H0755_030_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H0755	031	0	1	01	01	H0755_031_0	5	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H0755	032	0	1	01	01	H0755_032_0	3		2																																																																																									
H0755	807	0	1	02	01	H0755_807_0	2		1																																																																																									
H0755	808	0	1	02	01	H0755_808_0	2		2																																																																																									
H0755	810	0	1	01	01	H0755_810_0	2		1																																																																																									
H0755	811	0	1	01	01	H0755_811_0	2		2																																																																																									
H0755	812	0	1	01	01	H0755_812_0	2		1																																																																																									
H0773	001	0	1	48	05	H0773_001_0	7	MM_6A	1	4	110110	1	1		2	1	1	1	2			6	2																					1			Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs, Non-Medicare OTC Brand Drugs		3								1	1	1111				1			2	1	001000	2		3		111111			1																						
H0809	001	0	1	20	08	H0809_001_0	1		1																																																																																									
H0809	002	0	1	20	08	H0809_002_0	1		1																																																																																									
H0819	001	0	1	20	08	H0819_001_0	2		1																																																																																									
H0819	002	0	1	20	08	H0819_002_0	3		1																																																																																									
H0838	020	0	1	01	01	H0838_020_0	8		1	1	110110	2	1	1		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H0838	022	0	1	01	01	H0838_022_0	7	5A	1	4	110110	2	1	1	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0838	023	0	1	01	01	H0838_023_0	7		1	1	110110	2	1	1		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H0838	024	0	1	01	01	H0838_024_0	6		1	1	110110	2	1	1		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H0838	025	0	1	01	01	H0838_025_0	7	5A	1	4	110110	2	1	1	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H0838	026	0	1	01	01	H0838_026_0	6	5A	1	4	110110	2	1	1	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0838	027	0	1	01	01	H0838_027_0	7		1	1	110110	2	1	1		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H0838	028	0	1	01	01	H0838_028_0	6	5A	1	4	110110	2	1	1	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H0838	029	0	1	01	01	H0838_029_0	6		1	1	110110	2	1	1		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H0839	001	0	1	20	08	H0839_001_0	1		1																																																																																									
H0839	002	0	1	20	08	H0839_002_0	1		1																																																																																									
H0840	001	0	1	04	01	H0840_001_0	16	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	1						3	1	0110	2			2	3							1			2																								
H0840	002	0	1	04	01	H0840_002_0	13		2																																																																																									
H0879	001	0	1	04	01	H0879_001_0	14	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H0879	002	0	1	04	01	H0879_002_0	14	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H0879	004	0	1	04	01	H0879_004_0	6		2																																																																																									
H0879	801	0	1	04	01	H0879_801_0	2		1																																																																																									
H0879	802	0	1	04	01	H0879_802_0	2		1																																																																																									
H0879	803	0	1	04	01	H0879_803_0	2		2																																																																																									
H0901	004	0	1	01	01	H0901_004_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H0901	801	0	1	01	01	H0901_801_0	1		2																																																																																									
H0901	802	0	1	01	01	H0901_802_0	1		1																																																																																									
H0908	001	0	1	01	01	H0908_001_0	8	4E	1	4	110110	1	1	2	2	1	1	2	2			4	3			5																					Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H0913	002	0	1	01	01	H0913_002_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H0927	001	0	1	48	05	H0927_001_0	8	MM_3C	1	4	110110	1	1		2	1	1	1	2			3	2																		3						Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			1			2		3		011100			1																						
H0979	021	0	1	09	04	H0979_021_0	3		2																																																																																									
H0979	022	0	1	09	04	H0979_022_0	4	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H1013	011	0	1	01	01	H1013_011_0	15	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	4000.00	010000	2																								
H1013	021	0	1	01	01	H1013_021_0	8	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H1013	024	0	1	01	01	H1013_024_0	8	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H1013	802	0	1	01	01	H1013_802_0	5		1																																																																																									
H1013	803	0	1	01	01	H1013_803_0	5		2																																																																																									
H1013	805	0	1	01	01	H1013_805_0	5		1																																																																																									
H1016	001	0	1	01	01	H1016_001_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	2		1	2		1	3							2	5000.00	011000	2																								
H1016	021	0	1	01	01	H1016_021_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	2		1	2		1	3							2	3000.00	001000	2																								
H1016	022	0	1	01	01	H1016_022_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	2		1	2		1	3							2	3000.00	001000	2																								
H1016	801	0	1	01	01	H1016_801_0	3		1																																																																																									
H1016	802	0	1	01	01	H1016_802_0	3		2																																																																																									
H1016	803	0	1	01	01	H1016_803_0	3		1																																																																																									
H1016	804	0	1	01	01	H1016_804_0	3		2																																																																																									
H1019	001	0	1	01	01	H1019_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1019	006	0	1	01	01	H1019_006_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	7000.00	011111	2																								
H1019	010	0	1	01	01	H1019_010_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	014	0	1	01	01	H1019_014_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1019	023	0	1	01	01	H1019_023_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	024	0	1	01	01	H1019_024_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	025	0	1	01	01	H1019_025_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	026	0	1	01	01	H1019_026_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	027	0	1	01	01	H1019_027_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	028	0	1	01	01	H1019_028_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	032	0	1	01	01	H1019_032_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1019	043	0	1	01	01	H1019_043_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	045	0	1	01	01	H1019_045_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1019	046	0	1	01	01	H1019_046_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	047	0	1	01	01	H1019_047_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	048	0	1	01	01	H1019_048_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	049	0	1	01	01	H1019_049_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	050	0	1	01	01	H1019_050_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	054	0	1	01	01	H1019_054_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1019	057	0	1	01	01	H1019_057_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	059	0	1	01	01	H1019_059_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1019	060	0	1	01	01	H1019_060_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	061	0	1	01	01	H1019_061_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	062	0	1	01	01	H1019_062_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	063	0	1	01	01	H1019_063_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	2			1	3							2	7000.00	011111	2																								
H1019	064	0	1	01	01	H1019_064_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	065	0	1	01	01	H1019_065_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	066	0	1	01	01	H1019_066_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1019	067	0	1	01	01	H1019_067_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	068	0	1	01	01	H1019_068_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	069	0	1	01	01	H1019_069_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1019	070	0	1	01	01	H1019_070_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1019	071	0	1	01	01	H1019_071_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1019	072	0	1	01	01	H1019_072_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1019	073	0	1	01	01	H1019_073_0	3	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	010000	1				2							3							1			2																								
H1019	074	0	1	01	01	H1019_074_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1019	075	0	1	01	01	H1019_075_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	2			1	3							2	7000.00	011111	2																								
H1019	076	0	1	01	01	H1019_076_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1026	001	0	1	01	01	H1026_001_0	13	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011001	2																								
H1026	038	0	1	01	01	H1026_038_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011001	2																								
H1026	040	0	1	01	01	H1026_040_0	10	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011001	2																								
H1026	048	0	1	01	01	H1026_048_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1026	051	0	1	01	01	H1026_051_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1026	054	0	1	01	01	H1026_054_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1032	002	0	1	02	01	H1032_002_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	025	0	1	02	01	H1032_025_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	032	0	1	01	01	H1032_032_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	035	0	1	02	01	H1032_035_0	7	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	037	0	1	01	01	H1032_037_0	6		2																																																																																									
H1032	040	0	1	02	01	H1032_040_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	061	0	1	01	01	H1032_061_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1032	073	0	1	01	01	H1032_073_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	079	0	1	01	01	H1032_079_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	091	0	1	02	01	H1032_091_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	124	0	1	01	01	H1032_124_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1032	133	0	1	02	01	H1032_133_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	170	0	1	01	01	H1032_170_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1032	173	0	1	01	01	H1032_173_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	174	0	1	01	01	H1032_174_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	175	0	1	01	01	H1032_175_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1032	176	0	1	01	01	H1032_176_0	6	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1032	177	0	1	01	01	H1032_177_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1032	179	0	1	01	01	H1032_179_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1035	002	0	1	02	01	H1035_002_0	7	5A8	1	4	101110	2	1	2	2	1	1	1	2			6	4											1	2												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs		3								2	1	0110	2			1	3							1		011000	2																								
H1035	006	0	1	01	01	H1035_006_0	5	5A8	1	4	101110	2	1	2	2	1	1	1	2			6	4											1	2												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs		2	160.00	1						2	1	0110	2			2	3							1			2																								
H1035	007	0	1	02	01	H1035_007_0	3		2																																																																																									
H1035	009	0	1	01	01	H1035_009_0	4		1	1	110110	2	1	2		1	1	1	2																																																										110	31		93					01	31		110	31		93					1	31	1
H1035	801	0	1	01	01	H1035_801_0	1		1																																																																																									
H1035	802	0	1	01	01	H1035_802_0	1		1																																																																																									
H1036	025	0	1	01	01	H1036_025_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	040	0	1	01	01	H1036_040_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	044	0	1	01	01	H1036_044_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	052	0	1	01	01	H1036_052_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	053	0	1	01	01	H1036_053_0	5		2																																																																																									
H1036	054	0	1	01	01	H1036_054_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	7000.00	011111	2																								
H1036	056	0	1	01	01	H1036_056_0	2		2																																																																																									
H1036	062	0	1	01	01	H1036_062_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	063	0	1	01	01	H1036_063_0	3		2																																																																																									
H1036	065	0	1	01	01	H1036_065_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	067	0	1	01	01	H1036_067_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	068	0	1	01	01	H1036_068_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	074	0	1	01	01	H1036_074_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	077	0	1	01	01	H1036_077_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1036	081	0	1	01	01	H1036_081_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	102	0	1	01	01	H1036_102_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1036	103	0	1	01	01	H1036_103_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1036	104	0	1	01	01	H1036_104_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1036	119	0	1	01	01	H1036_119_0	3		2																																																																																									
H1036	121	0	1	01	01	H1036_121_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	130	0	1	01	01	H1036_130_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	137	0	1	01	01	H1036_137_0	12	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	138	0	1	01	01	H1036_138_0	11	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	140	0	1	01	01	H1036_140_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	141	0	1	01	01	H1036_141_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	143	0	1	01	01	H1036_143_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	146	0	1	01	01	H1036_146_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	151	0	1	01	01	H1036_151_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H1036	152	0	1	01	01	H1036_152_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1036	153	0	1	01	01	H1036_153_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	154	0	1	01	01	H1036_154_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	156	0	1	01	01	H1036_156_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	157	0	1	01	01	H1036_157_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	159	0	1	01	01	H1036_159_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1036	160	0	1	01	01	H1036_160_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	161	0	1	01	01	H1036_161_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1036	162	0	1	01	01	H1036_162_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1036	163	0	1	01	01	H1036_163_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		2	3							1			2																								
H1036	164	0	1	01	01	H1036_164_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	167	0	1	01	01	H1036_167_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	010000	1				2							3							1			2																								
H1036	168	0	1	01	01	H1036_168_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	70.00	2	010000	1				2							3							1			2																								
H1036	169	0	1	01	01	H1036_169_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	010000	1				2							3							1			2																								
H1036	170	0	1	01	01	H1036_170_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	010000	1				2							3							1			2																								
H1036	171	0	1	01	01	H1036_171_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H1036	175	0	1	01	01	H1036_175_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	178	0	1	01	01	H1036_178_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H1036	179	0	1	01	01	H1036_179_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H1036	184	0	1	01	01	H1036_184_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	185	0	1	01	01	H1036_185_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	186	0	1	01	01	H1036_186_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	187	0	1	01	01	H1036_187_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	188	0	1	01	01	H1036_188_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	7000.00	011111	2																								
H1036	189	0	1	01	01	H1036_189_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	2			1	3							2	7000.00	011111	2																								
H1036	190	0	1	01	01	H1036_190_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	192	0	1	01	01	H1036_192_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	193	0	1	01	01	H1036_193_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011111	2																								
H1036	194	0	1	01	01	H1036_194_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	195	0	1	01	01	H1036_195_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	196	0	1	01	01	H1036_196_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	199	0	1	01	01	H1036_199_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	209	0	1	01	01	H1036_209_0	3	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	270.00	2	010000	1				2							3							1			2																								
H1036	210	0	1	01	01	H1036_210_0	3	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	190.00	2	010000	1				2							3							1			2																								
H1036	211	0	1	01	01	H1036_211_0	3	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	270.00	2	010000	1				2							3							1			2																								
H1036	212	0	1	01	01	H1036_212_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	213	0	1	01	01	H1036_213_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	214	0	1	01	01	H1036_214_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	215	0	1	01	01	H1036_215_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	217	0	1	01	01	H1036_217_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	218	0	1	01	01	H1036_218_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	219	0	1	01	01	H1036_219_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	220	0	1	02	01	H1036_220_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	222	0	1	01	01	H1036_222_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	010000	1				2							3							1			2																								
H1036	223	0	1	01	01	H1036_223_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H1036	224	0	1	01	01	H1036_224_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	225	0	1	01	01	H1036_225_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	226	0	1	01	01	H1036_226_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	227	0	1	01	01	H1036_227_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	228	0	1	01	01	H1036_228_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
H1036	229	0	1	01	01	H1036_229_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1036	801	0	1	01	01	H1036_801_0	2		1																																																																																									
H1036	806	0	1	01	01	H1036_806_0	2		2																																																																																									
H1036	807	0	1	01	01	H1036_807_0	2		1																																																																																									
H1036	809	0	1	01	01	H1036_809_0	2		1																																																																																									
H1036	810	0	1	01	01	H1036_810_0	2		1																																																																																									
H1036	811	0	1	01	01	H1036_811_0	2		2																																																																																									
H1036	812	0	1	01	01	H1036_812_0	2		1																																																																																									
H1036	813	0	1	01	01	H1036_813_0	2		1																																																																																									
H1043	001	0	1	20	08	H1043_001_0	1		1																																																																																									
H1043	002	0	1	20	08	H1043_002_0	1		1																																																																																									
H1045	001	0	1	02	01	H1045_001_0	6	4B	1	4	110101	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	7000.00	010000	2																								
H1045	005	0	1	01	01	H1045_005_0	5	4B	1	4	110101	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	2			1	3							2	3250.00	010000	2																								
H1045	012	0	1	02	01	H1045_012_0	5	4B	1	4	110110	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H1045	016	0	1	01	01	H1045_016_0	6	4B	1	4	110101	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	6000.00	011000	2																								
H1045	018	0	1	01	01	H1045_018_0	5	4B	1	4	110101	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	2			1	3							2	5000.00	010000	2																								
H1045	023	0	1	01	01	H1045_023_0	4	4B	1	4	110101	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1045	025	0	1	01	01	H1045_025_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H1076	011	0	1	01	01	H1076_011_0	13	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H1076	802	0	1	01	01	H1076_802_0	3		1																																																																																									
H1076	803	0	1	01	01	H1076_803_0	3		2																																																																																									
H1076	805	0	1	01	01	H1076_805_0	3		1																																																																																									
H1080	004	0	1	01	01	H1080_004_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1080	036	0	1	01	01	H1080_036_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H1080	042	0	1	01	01	H1080_042_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1080	043	0	1	01	01	H1080_043_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1080	801	0	1	01	01	H1080_801_0	2		1																																																																																									
H1080	804	0	1	01	01	H1080_804_0	2		2																																																																																									
H1080	807	0	1	01	01	H1080_807_0	2		1																																																																																									
H1080	808	0	2	01	01	H1080_808_0	2		1																																																																																									
H1099	001	0	1	02	01	H1099_001_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H1099	006	0	1	01	01	H1099_006_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H1099	009	0	1	01	01	H1099_009_0	6		2																																																																																									
H1099	014	0	1	01	01	H1099_014_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H1099	016	0	1	01	01	H1099_016_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H1099	017	0	1	02	01	H1099_017_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H1099	802	0	1	01	01	H1099_802_0	3		1																																																																																									
H1099	804	0	1	02	01	H1099_804_0	3		1																																																																																									
H1108	001	0	1	04	01	H1108_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H1108	002	0	1	04	01	H1108_002_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H1109	001	0	1	01	01	H1109_001_0	7	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H1109	005	0	1	01	01	H1109_005_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H1109	801	0	1	01	01	H1109_801_0	2		2																																																																																									
H1109	802	0	1	01	01	H1109_802_0	2		1																																																																																									
H1110	001	0	1	04	01	H1110_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H1110	801	0	1	04	01	H1110_801_0	1		2																																																																																									
H1110	802	0	1	04	01	H1110_802_0	1		1																																																																																									
H1110	805	0	2	04	01	H1110_805_0	2		2																																																																																									
H1110	806	0	2	04	01	H1110_806_0	1		1																																																																																									
H1111	002	0	1	01	01	H1111_002_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1111	006	0	1	01	01	H1111_006_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1111	801	0	1	01	01	H1111_801_0	2		1																																																																																									
H1111	804	0	1	01	01	H1111_804_0	2		2																																																																																									
H1111	805	0	1	01	01	H1111_805_0	2		1																																																																																									
H1111	807	0	2	01	01	H1111_807_0	2		1																																																																																									
H1112	006	0	1	01	01	H1112_006_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1112	027	0	1	02	01	H1112_027_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1170	002	0	1	01	01	H1170_002_0	6	5A5	1	4	101110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H1170	008	0	1	01	01	H1170_008_0	6	5A5	1	3	101110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1							3							1			3																								
H1170	009	0	1	01	01	H1170_009_0	4	5A5	1	4	101110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H1170	801	0	1	01	01	H1170_801_0	3		2																																																																																									
H1170	802	0	1	01	01	H1170_802_0	4		1																																																																																									
H1170	805	0	1	01	01	H1170_805_0	3		1																																																																																									
H1216	001	0	1	02	01	H1216_001_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1216	003	0	1	01	01	H1216_003_0	4	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1230	001	0	1	01	01	H1230_001_0	6	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H1230	003	0	1	01	01	H1230_003_0	4	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H1230	005	0	1	01	01	H1230_005_0	5	5A5	1	3	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1							3							1			3																								
H1230	006	0	1	01	01	H1230_006_0	4	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H1230	801	0	1	01	01	H1230_801_0	3		2																																																																																									
H1230	803	0	1	01	01	H1230_803_0	3		1																																																																																									
H1230	804	0	2	01	01	H1230_804_0	3		1																																																																																									
H1230	805	0	1	01	01	H1230_805_0	4		1																																																																																									
H1230	806	0	2	01	01	H1230_806_0	4		1																																																																																									
H1234	001	0	1	20	08	H1234_001_0	1		1																																																																																									
H1234	002	0	1	20	08	H1234_002_0	1		1																																																																																									
H1239	001	0	1	20	08	H1239_001_0	1		1																																																																																									
H1239	002	0	1	20	08	H1239_002_0	1		1																																																																																									
H1264	004	0	1	02	01	H1264_004_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1264	007	0	1	01	01	H1264_007_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1264	008	0	1	01	01	H1264_008_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1264	018	0	1	01	01	H1264_018_0	6	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1286	002	0	1	01	01	H1286_002_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1286	003	0	1	01	01	H1286_003_0	3		2																																																																																									
H1286	009	0	1	01	01	H1286_009_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1286	804	0	1	02	01	H1286_804_0	2		2																																																																																									
H1291	001	0	1	09	04	H1291_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1302	001	0	1	04	01	H1302_001_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	1						2	1	0110	2			2	3							1			2																								
H1302	004	0	1	04	01	H1302_004_0	3		2																																																																																									
H1302	006	0	1	04	01	H1302_006_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	1						2	1	0110	2			2	3							1			2																								
H1303	001	0	1	04	01	H1303_001_0	6	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H1303	007	0	1	04	01	H1303_007_0	6	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H1304	001	0	1	04	01	H1304_001_0	8		2																																																																																									
H1304	002	0	1	04	01	H1304_002_0	15	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	1						1							3							1			2																								
H1304	004	0	1	04	01	H1304_004_0	12	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		010000	2																								
H1304	008	0	1	04	01	H1304_008_0	8		2																																																																																									
H1304	009	0	1	04	01	H1304_009_0	12	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	1						1							3							1			2																								
H1304	010	0	1	04	01	H1304_010_0	12	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		010000	2																								
H1304	803	0	1	04	01	H1304_803_0	4		2																																																																																									
H1304	804	0	1	04	01	H1304_804_0	4		1																																																																																									
H1310	001	0	1	20	08	H1310_001_0	2		1																																																																																									
H1310	003	0	1	20	08	H1310_003_0	1		1																																																																																									
H1350	001	0	1	01	01	H1350_001_0	3	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H1350	006	0	1	01	01	H1350_006_0	2		2																																																																																									
H1350	009	0	1	01	01	H1350_009_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H1350	010	0	1	01	01	H1350_010_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1350	012	0	1	02	01	H1350_012_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1357	001	0	1	20	08	H1357_001_0	1		1																																																																																									
H1357	002	0	1	20	08	H1357_002_0	1		1																																																																																									
H1365	001	0	1	04	01	H1365_001_0	11	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1365	002	0	1	04	01	H1365_002_0	8	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1365	003	0	1	04	01	H1365_003_0	10	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1365	802	0	1	04	01	H1365_802_0	4		1																																																																																									
H1365	803	0	1	04	01	H1365_803_0	4		1																																																																																									
H1367	001	0	1	01	01	H1367_001_0	7		1	1	110110	1	1	2		1	1	1	1	1	1																																																								111	30	60	90					01	30		100			90					1	31	2
H1367	002	0	1	01	01	H1367_002_0	10	4A	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	010000	1				1	1	0110	2			2	3							1			2																								
H1406	013	0	1	01	01	H1406_013_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1406	022	0	1	01	01	H1406_022_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1406	026	0	1	01	01	H1406_026_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1406	027	0	1	01	01	H1406_027_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1406	028	0	1	01	01	H1406_028_0	9	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1406	029	0	1	01	01	H1406_029_0	10	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1406	030	0	1	01	01	H1406_030_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1406	031	0	1	01	01	H1406_031_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	75.00	2	011000	1				2							3							1			2																								
H1406	801	0	1	01	01	H1406_801_0	2		1																																																																																									
H1406	802	0	1	01	01	H1406_802_0	2		2																																																																																									
H1406	803	0	1	01	01	H1406_803_0	2		1																																																																																									
H1415	005	0	1	01	01	H1415_005_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H1415	013	0	1	01	01	H1415_013_0	2		2																																																																																									
H1415	021	0	1	02	01	H1415_021_0	3	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H1415	024	0	1	01	01	H1415_024_0	3		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H1416	007	0	1	01	01	H1416_007_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1416	009	0	1	02	01	H1416_009_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1416	019	0	1	01	01	H1416_019_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1417	001	0	1	04	01	H1417_001_0	7		2																																																																																									
H1417	002	0	1	04	01	H1417_002_0	11	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	230.00	2	011000	1				1							3							1			2																								
H1417	003	0	1	04	01	H1417_003_0	7		2																																																																																									
H1417	004	0	1	04	01	H1417_004_0	11	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	230.00	2	011000	1				1							3							1			2																								
H1417	801	0	1	04	01	H1417_801_0	3		2																																																																																									
H1417	802	0	1	04	01	H1417_802_0	3		1																																																																																									
H1417	810	0	1	04	01	H1417_810_0	3		1																																																																																									
H1418	002	0	1	04	01	H1418_002_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1418	007	0	1	04	01	H1418_007_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1418	008	0	1	04	01	H1418_008_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H1419	001	0	1	01	01	H1419_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H1419	801	0	1	01	01	H1419_801_0	1		2																																																																																									
H1419	802	0	1	01	01	H1419_802_0	1		1																																																																																									
H1444	001	0	1	01	01	H1444_001_0	5	5A	1	4	110100	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			1	3							1		011000	2																								
H1463	001	0	1	01	01	H1463_001_0	7		2																																																																																									
H1463	003	0	1	01	01	H1463_003_0	11	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	270.00	2	011000	1				1							3							1			2																								
H1463	008	0	1	01	01	H1463_008_0	7		2																																																																																									
H1463	009	0	1	01	01	H1463_009_0	10	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	290.00	2	011000	1				1							3							1			2																								
H1463	801	0	1	01	01	H1463_801_0	3		2																																																																																									
H1463	802	0	1	01	01	H1463_802_0	3		1																																																																																									
H1463	810	0	1	01	01	H1463_810_0	3		1																																																																																									
H1468	007	0	1	01	01	H1468_007_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1468	802	0	1	01	01	H1468_802_0	2		1																																																																																									
H1468	803	0	1	01	01	H1468_803_0	2		2																																																																																									
H1468	804	0	1	01	01	H1468_804_0	2		1																																																																																									
H1500	001	0	1	20	08	H1500_001_0	1		1																																																																																									
H1500	002	0	1	20	08	H1500_002_0	1		1																																																																																									
H1509	001	0	1	04	01	H1509_001_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1509	007	0	1	04	01	H1509_007_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H1509	009	0	1	04	01	H1509_009_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1509	010	0	1	04	01	H1509_010_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H1509	801	0	1	04	01	H1509_801_0	2		1																																																																																									
H1509	803	0	1	04	01	H1509_803_0	2		2																																																																																									
H1509	804	0	1	04	01	H1509_804_0	2		1																																																																																									
H1509	806	0	2	04	01	H1509_806_0	2		1																																																																																									
H1509	807	0	2	04	01	H1509_807_0	2		2																																																																																									
H1509	808	0	2	04	01	H1509_808_0	2		1																																																																																									
H1509	809	0	1	04	01	H1509_809_0	2		1																																																																																									
H1509	810	0	1	04	01	H1509_810_0	2		2																																																																																									
H1509	811	0	1	04	01	H1509_811_0	2		1																																																																																									
H1509	812	0	1	04	01	H1509_812_0	2		1																																																																																									
H1509	813	0	1	04	01	H1509_813_0	3		1																																																																																									
H1509	814	0	1	04	01	H1509_814_0	2		1																																																																																									
H1509	815	0	1	04	01	H1509_815_0	2		1																																																																																									
H1509	816	0	1	04	01	H1509_816_0	2		1																																																																																									
H1509	817	0	1	04	01	H1509_817_0	2		1																																																																																									
H1509	819	0	1	04	01	H1509_819_0	2		1																																																																																									
H1510	001	0	1	04	01	H1510_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1510	004	0	1	04	01	H1510_004_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1510	005	0	1	04	01	H1510_005_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1510	008	0	1	04	01	H1510_008_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1517	004	0	1	04	01	H1517_004_0	6	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	60.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H1517	005	0	1	04	01	H1517_005_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	130.00	2	110001	1				2							3							1			2																								
H1517	801	0	1	04	01	H1517_801_0	2		1																																																																																									
H1517	802	0	1	04	01	H1517_802_0	2		2																																																																																									
H1517	803	0	1	04	01	H1517_803_0	3		1																																																																																									
H1518	001	0	1	20	08	H1518_001_0	1		1																																																																																									
H1518	002	0	1	20	08	H1518_002_0	1		1																																																																																									
H1533	001	0	1	20	08	H1533_001_0	1		1																																																																																									
H1533	002	0	1	20	08	H1533_002_0	1		1																																																																																									
H1537	001	0	1	04	01	H1537_001_0	6	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H1537	801	0	1	04	01	H1537_801_0	2		1																																																																																									
H1537	802	0	1	04	01	H1537_802_0	2		2																																																																																									
H1537	803	0	1	04	01	H1537_803_0	2		1																																																																																									
H1537	804	0	2	04	01	H1537_804_0	2		1																																																																																									
H1537	805	0	2	04	01	H1537_805_0	2		2																																																																																									
H1537	806	0	2	04	01	H1537_806_0	2		1																																																																																									
H1537	807	0	1	04	01	H1537_807_0	2		1																																																																																									
H1537	808	0	1	04	01	H1537_808_0	2		2																																																																																									
H1537	809	0	1	04	01	H1537_809_0	2		1																																																																																									
H1537	816	0	1	04	01	H1537_816_0	2		1																																																																																									
H1537	817	0	1	04	01	H1537_817_0	2		1																																																																																									
H1537	818	0	1	04	01	H1537_818_0	2		1																																																																																									
H1537	819	0	1	04	01	H1537_819_0	2		1																																																																																									
H1537	820	0	1	04	01	H1537_820_0	2		1																																																																																									
H1537	821	0	1	04	01	H1537_821_0	2		1																																																																																									
H1595	002	0	1	04	01	H1595_002_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H1595	003	0	1	04	01	H1595_003_0	7	4A	1	3	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1							3							1			2																								
H1595	801	0	1	04	01	H1595_801_0	2		2																																																																																									
H1595	802	0	1	04	01	H1595_802_0	4		1																																																																																									
H1595	804	0	1	04	01	H1595_804_0	4		1																																																																																									
H1607	001	0	1	04	01	H1607_001_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	95.00	2	110001	1				2							3							1			2																								
H1607	804	0	1	04	01	H1607_804_0	2		1																																																																																									
H1607	805	0	1	04	01	H1607_805_0	2		2																																																																																									
H1607	806	0	1	04	01	H1607_806_0	3		1																																																																																									
H1608	001	0	1	04	01	H1608_001_0	10	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1608	004	0	1	04	01	H1608_004_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1608	007	0	1	04	01	H1608_007_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1608	008	0	1	04	01	H1608_008_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1608	801	0	1	04	01	H1608_801_0	5		2																																																																																									
H1608	802	0	1	04	01	H1608_802_0	5		1																																																																																									
H1608	803	0	1	04	01	H1608_803_0	5		1																																																																																									
H1609	001	0	1	01	01	H1609_001_0	9	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1609	009	0	1	01	01	H1609_009_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1609	010	0	1	01	01	H1609_010_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1609	801	0	1	01	01	H1609_801_0	4		2																																																																																									
H1609	802	0	1	01	01	H1609_802_0	4		1																																																																																									
H1609	803	0	1	01	01	H1609_803_0	4		1																																																																																									
H1651	001	0	1	18	06	H1651_001_0	2		2																																																																																									
H1651	002	0	1	18	06	H1651_002_0	2		2																																																																																									
H1651	003	0	1	18	06	H1651_003_0	2		2																																																																																									
H1651	004	0	1	18	06	H1651_004_0	2		2																																																																																									
H1651	005	0	1	18	06	H1651_005_0	2		2																																																																																									
H1651	008	0	1	18	06	H1651_008_0	2		2																																																																																									
H1651	009	0	1	18	06	H1651_009_0	2		2																																																																																									
H1659	001	0	1	04	01	H1659_001_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1659	002	0	1	04	01	H1659_002_0	8	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1659	003	0	1	04	01	H1659_003_0	9	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1660	001	0	1	01	01	H1660_001_0	7	4C	1	4	110110	1	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		3								1	1	0110	2			1	3							1		011000	2																								
H1660	004	0	1	01	01	H1660_004_0	7	4C	1	4	110110	1	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		3								1	1	0110	2			1	3							1		011000	2																								
H1660	005	0	1	01	01	H1660_005_0	9	4C	1	4	110110	1	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		3								1	1	0110	2			1	3							1		011000	2																								
H1660	801	0	1	01	01	H1660_801_0	6		1																																																																																									
H1660	802	0	1	01	01	H1660_802_0	6		1																																																																																									
H1666	001	0	1	04	01	H1666_001_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1666	002	0	1	04	01	H1666_002_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1666	003	0	1	04	01	H1666_003_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1666	004	0	1	04	01	H1666_004_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1666	005	0	1	04	01	H1666_005_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1666	006	0	1	04	01	H1666_006_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1666	801	0	1	04	01	H1666_801_0	2		1																																																																																									
H1666	802	0	1	04	01	H1666_802_0	2		1																																																																																									
H1666	803	0	1	04	01	H1666_803_0	2		1																																																																																									
H1666	804	0	1	04	01	H1666_804_0	2		1																																																																																									
H1666	805	0	1	04	01	H1666_805_0	2		2																																																																																									
H1666	806	0	1	04	01	H1666_806_0	2		2																																																																																									
H1681	001	0	1	04	01	H1681_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011000	1				2	1	0110	2			1	3							1		011111	2																								
H1681	002	0	1	04	01	H1681_002_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2							3							1			2																								
H1681	005	0	1	04	01	H1681_005_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H1681	006	0	1	04	01	H1681_006_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1692	001	0	1	01	01	H1692_001_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1692	002	0	1	01	01	H1692_002_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1692	801	0	1	01	01	H1692_801_0	6		2																																																																																									
H1692	802	0	1	01	01	H1692_802_0	6		1																																																																																									
H1692	803	0	1	01	01	H1692_803_0	5		1																																																																																									
H1714	001	0	1	20	08	H1714_001_0	1		1																																																																																									
H1714	002	0	1	20	08	H1714_002_0	1		1																																																																																									
H1716	001	0	1	04	01	H1716_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1716	006	0	1	04	01	H1716_006_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1716	020	0	1	04	01	H1716_020_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	225.00	2	011000	1				2	1	0110	2			1	3							1		001111	2																								
H1717	009	0	1	04	01	H1717_009_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H1737	001	0	1	01	01	H1737_001_0	7	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	80.00	2	011000	1				1							3							1			2																								
H1737	801	0	1	01	01	H1737_801_0	1		2																																																																																									
H1737	802	0	1	01	01	H1737_802_0	1		1																																																																																									
H1737	803	0	1	01	01	H1737_803_0	1		1																																																																																									
H1777	007	0	1	01	01	H1777_007_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	1
H1846	001	0	1	04	01	H1846_001_0	4	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H1846	003	0	1	04	01	H1846_003_0	4	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1846	801	0	1	04	01	H1846_801_0	1		1																																																																																									
H1846	802	0	1	04	01	H1846_802_0	1		2																																																																																									
H1849	015	0	1	01	01	H1849_015_0	5	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	150.00	2	110001	1				2							3							1			2																								
H1849	801	0	1	01	01	H1849_801_0	2		1																																																																																									
H1849	803	0	1	01	01	H1849_803_0	2		2																																																																																									
H1849	804	0	1	01	01	H1849_804_0	2		1																																																																																									
H1894	001	0	1	01	01	H1894_001_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							2	2400.00	010000	2																								
H1894	002	0	1	01	01	H1894_002_0	7		1	1	110110	1	1	2		1	1	1	2																																																										111	31	62	93					01	31		111	31	62	93					1	31	2
H1903	011	0	1	01	01	H1903_011_0	4	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H1903	022	0	1	01	01	H1903_022_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1904	001	0	1	20	08	H1904_001_0	1		1																																																																																									
H1904	002	0	1	20	08	H1904_002_0	3		1																																																																																									
H1906	001	0	1	09	04	H1906_001_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1944	001	0	1	01	01	H1944_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1944	004	0	1	01	01	H1944_004_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H1951	001	0	1	01	01	H1951_001_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	005	0	1	01	01	H1951_005_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	013	0	1	01	01	H1951_013_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	024	0	1	01	01	H1951_024_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	025	0	1	01	01	H1951_025_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	028	0	1	01	01	H1951_028_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	030	0	1	01	01	H1951_030_0	2		2																																																																																									
H1951	032	0	1	01	01	H1951_032_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	175.00	2	010000	1				2							3							1			2																								
H1951	033	0	1	01	01	H1951_033_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	140.00	2	010000	1				2							3							1			2																								
H1951	034	0	1	01	01	H1951_034_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	130.00	2	010000	1				2							3							1			2																								
H1951	035	0	1	01	01	H1951_035_0	3	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	185.00	2	010000	1				2							3							1			2																								
H1951	036	0	1	01	01	H1951_036_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	037	0	1	01	01	H1951_037_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	038	0	1	01	01	H1951_038_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	039	0	1	01	01	H1951_039_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	041	0	1	01	01	H1951_041_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	190.00	2	010000	1				2							3							1			2																								
H1951	042	0	1	01	01	H1951_042_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	043	0	1	01	01	H1951_043_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H1951	801	0	1	01	01	H1951_801_0	2		1																																																																																									
H1951	804	0	1	01	01	H1951_804_0	2		2																																																																																									
H1951	805	0	1	01	01	H1951_805_0	2		1																																																																																									
H1961	001	0	1	01	01	H1961_001_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H1961	002	0	1	01	01	H1961_002_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H1961	003	0	1	01	01	H1961_003_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H1961	007	0	1	01	01	H1961_007_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H1961	008	0	1	01	01	H1961_008_0	4		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H1961	801	0	1	02	01	H1961_801_0	1		1																																																																																									
H1961	802	0	1	02	01	H1961_802_0	1		1																																																																																									
H1961	803	0	1	01	01	H1961_803_0	1		1																																																																																									
H1961	804	0	1	01	01	H1961_804_0	1		1																																																																																									
H1994	001	0	1	02	01	H1994_001_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1994	002	0	1	02	01	H1994_002_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1994	003	0	1	02	01	H1994_003_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1994	004	0	1	02	01	H1994_004_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H1994	801	0	1	02	01	H1994_801_0	2		1																																																																																									
H1994	802	0	1	02	01	H1994_802_0	2		2																																																																																									
H1994	803	0	1	02	01	H1994_803_0	2		1																																																																																									
H1997	002	0	1	01	01	H1997_002_0	8	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1							3							1			2																								
H2001	001	0	1	04	01	H2001_001_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2005	001	0	1	48	05	H2005_001_0	3	MM_3A	1	4	110110	1	1		2	1	1	1	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	2		2		3		011100			1																						
H2012	001	0	1	01	01	H2012_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	002	0	1	01	01	H2012_002_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H2012	003	0	1	01	01	H2012_003_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	006	0	1	02	01	H2012_006_0	9	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	007	0	1	01	01	H2012_007_0	11	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H2012	008	0	1	01	01	H2012_008_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	009	0	1	01	01	H2012_009_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	011	0	1	01	01	H2012_011_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	012	0	1	02	01	H2012_012_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	013	0	1	01	01	H2012_013_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	015	0	1	01	01	H2012_015_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	016	0	1	01	01	H2012_016_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	021	0	1	01	01	H2012_021_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H2012	022	0	1	01	01	H2012_022_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	027	0	1	01	01	H2012_027_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	028	0	1	01	01	H2012_028_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	029	0	1	01	01	H2012_029_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	030	0	1	02	01	H2012_030_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	031	0	1	01	01	H2012_031_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	033	0	1	01	01	H2012_033_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	035	0	1	01	01	H2012_035_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	037	0	1	01	01	H2012_037_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	039	0	1	01	01	H2012_039_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	042	0	1	01	01	H2012_042_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	85.00	2	010000	1				2							3							1			2																								
H2012	051	0	1	01	01	H2012_051_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	053	0	1	01	01	H2012_053_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	65.00	2	010000	1				2							3							1			2																								
H2012	054	0	1	01	01	H2012_054_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	185.00	2	010000	1				2							3							1			2																								
H2012	055	0	1	01	01	H2012_055_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	056	0	1	01	01	H2012_056_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	059	0	1	01	01	H2012_059_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	060	0	1	01	01	H2012_060_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	061	0	1	01	01	H2012_061_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	062	0	1	01	01	H2012_062_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	65.00	2	010000	1				2							3							1			2																								
H2012	063	0	1	01	01	H2012_063_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	95.00	2	010000	1				2							3							1			2																								
H2012	064	0	1	01	01	H2012_064_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	70.00	2	010000	1				2							3							1			2																								
H2012	070	0	1	01	01	H2012_070_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	185.00	2	010000	1				2							3							1			2																								
H2012	080	0	1	01	01	H2012_080_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	081	0	1	01	01	H2012_081_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H2012	082	0	1	01	01	H2012_082_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	084	0	1	01	01	H2012_084_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	085	0	1	01	01	H2012_085_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	087	0	1	01	01	H2012_087_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	210.00	2	011000	1				2							3							1			2																								
H2012	088	0	1	01	01	H2012_088_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	089	0	1	01	01	H2012_089_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	090	0	1	01	01	H2012_090_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	091	0	1	01	01	H2012_091_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2012	092	0	1	01	01	H2012_092_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	210.00	2	011000	1				2							3							1			2																								
H2012	093	0	1	01	01	H2012_093_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	280.00	2	011000	1				2							3							1			2																								
H2012	094	0	1	01	01	H2012_094_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	290.00	2	011000	1				2							3							1			2																								
H2012	095	0	1	01	01	H2012_095_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H2012	096	0	1	01	01	H2012_096_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H2012	097	0	1	01	01	H2012_097_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H2012	098	0	1	01	01	H2012_098_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H2012	801	0	1	01	01	H2012_801_0	2		1																																																																																									
H2012	802	0	1	01	01	H2012_802_0	2		2																																																																																									
H2012	803	0	1	01	01	H2012_803_0	2		1																																																																																									
H2029	001	0	1	04	01	H2029_001_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2029	002	0	1	04	01	H2029_002_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2029	801	0	1	04	01	H2029_801_0	2		1																																																																																									
H2029	802	0	1	04	01	H2029_802_0	2		2																																																																																									
H2029	803	0	1	04	01	H2029_803_0	2		1																																																																																									
H2029	805	0	2	04	01	H2029_805_0	1		1																																																																																									
H2029	806	0	2	04	01	H2029_806_0	1		2																																																																																									
H2029	807	0	2	04	01	H2029_807_0	1		1																																																																																									
H2029	808	0	1	04	01	H2029_808_0	2		1																																																																																									
H2034	001	0	1	01	01	H2034_001_0	8		1	1	110100	2	1	2		1	1	1	2																																																										010	31							01	31										1	31	
H2034	002	0	1	01	01	H2034_002_0	8		1	1	110100	2	1	2		1	1	1	2																																																										010	31							01	31										1	31	
H2064	001	0	1	20	08	H2064_001_0	1		1																																																																																									
H2064	002	0	1	20	08	H2064_002_0	1		1																																																																																									
H2108	001	0	1	01	01	H2108_001_0	2		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H2108	020	0	1	01	01	H2108_020_0	3		1	1	110100	1	1	2		1	1	1	2																																																										111	30	60	90					01	30										1	31	2
H2108	022	0	1	01	01	H2108_022_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	011000	1				2	1	0100	2			2	3							1			2																								
H2108	028	0	1	01	01	H2108_028_0	3	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H2108	029	0	1	01	01	H2108_029_0	3	5A6	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								2	1	0100	2			2	3							1			2																								
H2108	030	0	1	01	01	H2108_030_0	3	5A6	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		2	150.00	2	111000	1				2	1	0100	2			2	3							1			2																								
H2108	801	0	1	01	01	H2108_801_0	1		1																																																																																									
H2108	802	0	1	02	01	H2108_802_0	1		1																																																																																									
H2108	803	0	1	01	01	H2108_803_0	1		2																																																																																									
H2108	804	0	1	01	01	H2108_804_0	1		1																																																																																									
H2108	805	0	1	02	01	H2108_805_0	1		2																																																																																									
H2108	806	0	1	02	01	H2108_806_0	1		1																																																																																									
H2109	001	0	1	20	08	H2109_001_0	3		1																																																																																									
H2109	002	0	1	20	08	H2109_002_0	2		1																																																																																									
H2111	001	0	1	04	01	H2111_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H2111	008	0	1	04	01	H2111_008_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H2112	001	0	1	01	01	H2112_001_0	4		2																																																																																									
H2112	007	0	1	01	01	H2112_007_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H2112	801	0	1	01	01	H2112_801_0	1		2																																																																																									
H2112	802	0	1	01	01	H2112_802_0	1		1																																																																																									
H2150	002	0	1	18	06	H2150_002_0	4	5A5	1	4	101101	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H2150	009	0	1	18	06	H2150_009_0	4	5A5	1	3	101101	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1							3							1			3																								
H2150	017	0	1	18	06	H2150_017_0	3		2																																																																																									
H2150	021	0	1	18	06	H2150_021_0	3		2																																																																																									
H2150	022	0	1	18	06	H2150_022_0	3		2																																																																																									
H2150	029	0	2	18	06	H2150_029_0	4	5A5	1	3	101101	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1							3							1			3																								
H2150	030	0	2	18	06	H2150_030_0	2		2																																																																																									
H2150	801	0		18	06	H2150_801_0	3		1																																																																																									
H2150	805	0		18	06	H2150_805_0	3		1																																																																																									
H2150	806	0		18	06	H2150_806_0	3		1																																																																																									
H2150	807	0		18	06	H2150_807_0	3		1																																																																																									
H2161	001	0	1	01	01	H2161_001_0	11		1	1	110100	1	1	2		1	1	1	2																																																										111	30	60	90					01	30										1	31	1
H2161	002	0	1	01	01	H2161_002_0	9	5A	1	4	110100	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2165	004	0	1	01	01	H2165_004_0	3		2																																																																																									
H2165	005	0	1	01	01	H2165_005_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H2165	011	0	1	02	01	H2165_011_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H2165	018	0	1	01	01	H2165_018_0	3	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H2165	019	0	1	01	01	H2165_019_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H2165	804	0	1	01	01	H2165_804_0	1		1																																																																																									
H2165	806	0	1	02	01	H2165_806_0	1		1																																																																																									
H2165	807	0	1	01	01	H2165_807_0	1		2																																																																																									
H2165	808	0	1	01	01	H2165_808_0	1		1																																																																																									
H2165	809	0	1	02	01	H2165_809_0	1		2																																																																																									
H2165	810	0	1	02	01	H2165_810_0	1		1																																																																																									
H2174	001	0	1	01	01	H2174_001_0	6		1	1	110110	1	1	1		1	1	1	1	1	2																																																								111	31	60	90					01	31		111	31	60	90					1	31	1
H2174	003	0	1	01	01	H2174_003_0	5		1	1	110110	1	1	1		1	1	1	1	1	2																																																								111	31	60	90					01	31		111	31	60	90					1	31	1
H2174	004	0	1	01	01	H2174_004_0	4		2																																																																																									
H2174	005	0	1	01	01	H2174_005_0	6		1	1	110110	1	1	1		1	1	1	1	1	2																																																								111	31	60	90					01	31		111	31	60	90					1	31	1
H2174	008	0	1	01	01	H2174_008_0	5	5A	1	4	110110	1	1	1	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	125.00	2	011001	1				1	1	0110	2			2	3							1			2																								
H2218	001	0	1	20	08	H2218_001_0	1		1																																																																																									
H2218	002	0	1	20	08	H2218_002_0	1		1																																																																																									
H2219	001	0	1	20	08	H2219_001_0	1		1																																																																																									
H2219	002	0	1	20	08	H2219_002_0	1		1																																																																																									
H2220	001	0	1	20	08	H2220_001_0	1		1																																																																																									
H2220	002	0	1	20	08	H2220_002_0	1		1																																																																																									
H2221	001	0	1	20	08	H2221_001_0	1		1																																																																																									
H2221	002	0	1	20	08	H2221_002_0	1		1																																																																																									
H2222	002	0	1	20	08	H2222_002_0	1		1																																																																																									
H2222	003	0	1	20	08	H2222_003_0	1		1																																																																																									
H2223	001	0	1	20	08	H2223_001_0	1		1																																																																																									
H2223	002	0	1	20	08	H2223_002_0	1		1																																																																																									
H2224	001	0	1	01	01	H2224_001_0	8	3D	1	4	110110	1	1	2	2	1	1	1	2			3	3		4																						Preferred Generic, Preferred Brand, Specialty Tier		1		1						1	1	0001	1	2		1	3							2	2870.00	010000	2																								
H2224	003	0	1	01	01	H2224_003_0	10	3D	1	4	110110	1	1	2	2	1	1	1	2			3	3		4																						Preferred Generic, Preferred Brand, Specialty Tier		1		1						1	1	0001	1	2		1	3							2	2870.00	010000	2																								
H2225	001	0	1	01	01	H2225_001_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					10		10	111	31	60	90					1	31	2
H2226	001	0	1	01	01	H2226_001_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H2228	001	0	1	04	01	H2228_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H2228	002	0	1	04	01	H2228_002_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H2230	002	0	1	04	01	H2230_002_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2230	016	0	1	04	01	H2230_016_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			2	3							1			2																								
H2230	017	0	1	04	01	H2230_017_0	10	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			2	3							1			2																								
H2230	801	0	1	04	01	H2230_801_0	5		1																																																																																									
H2230	809	0	1	04	01	H2230_809_0	5		2																																																																																									
H2237	001	0	1	01	01	H2237_001_0	10	3A	1	3	110110	1	1	2	2	1	1	1	2			3	2		1																						Generic, Brand, Specialty Tier		1		2	010000	1				1							3							1			2																								
H2237	007	0	1	01	01	H2237_007_0	9	3A	1	3	110110	1	1	2	2	1	1	1	2			3	2		1																						Generic, Brand, Specialty Tier		1		2	010000	1				1							3							1			2																								
H2241	001	0	1	01	01	H2241_001_0	8	4B	1	4	110110	1	1	2	2	1	1	1	2			4	4			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H2256	001	1	1	01	01	H2256_001_1	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H2256	001	2	1	01	01	H2256_001_2	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H2256	001	6	1	01	01	H2256_001_6	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H2256	015	1	1	01	01	H2256_015_1	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	015	2	1	01	01	H2256_015_2	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	015	6	1	01	01	H2256_015_6	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	016	1	1	01	01	H2256_016_1	3		2																																																																																									
H2256	016	2	1	01	01	H2256_016_2	3		2																																																																																									
H2256	016	6	1	01	01	H2256_016_6	3		2																																																																																									
H2256	018	1	1	01	01	H2256_018_1	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	018	7	1	01	01	H2256_018_7	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	018	8	1	01	01	H2256_018_8	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	019	1	1	01	01	H2256_019_1	3		2																																																																																									
H2256	019	7	1	01	01	H2256_019_7	3		2																																																																																									
H2256	019	8	1	01	01	H2256_019_8	4		2																																																																																									
H2256	026	1	1	01	01	H2256_026_1	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	026	2	1	01	01	H2256_026_2	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	026	3	1	01	01	H2256_026_3	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	028	0	1	01	01	H2256_028_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	029	0	1	01	01	H2256_029_0	8		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	2
H2256	033	0	1	01	01	H2256_033_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	034	0	1	01	01	H2256_034_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	036	0	1	01	01	H2256_036_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2256	039	0	1	01	01	H2256_039_0	2		2																																																																																									
H2256	040	0	1	01	01	H2256_040_0	2		2																																																																																									
H2256	041	0	1	01	01	H2256_041_0	2		2																																																																																									
H2256	042	0	1	01	01	H2256_042_0	1		2																																																																																									
H2256	801	0	1	01	01	H2256_801_0	2		1																																																																																									
H2256	802	0	1	01	01	H2256_802_0	2		2																																																																																									
H2256	803	0	1	01	01	H2256_803_0	2		1																																																																																									
H2261	005	0	1	01	01	H2261_005_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	120.00	2	011000	1				1	1	0100	2			2	3							1			2																								
H2261	019	0	1	01	01	H2261_019_0	10	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			2	3							1			2																								
H2261	801	0	1	01	01	H2261_801_0	4		1																																																																																									
H2261	809	0	1	01	01	H2261_809_0	3		2																																																																																									
H2312	004	0	1	01	01	H2312_004_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011000	1				2	1	0100	1	2		2	3							1			2																								
H2312	006	0	1	01	01	H2312_006_0	5		2																																																																																									
H2312	007	0	1	02	01	H2312_007_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011000	1				2	1	0100	1	2		2	3							1			2																								
H2312	010	0	1	02	01	H2312_010_0	10	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	50.00	2	011000	1				2	1	0100	1	2		1	3							1		011000	2																								
H2312	012	0	1	02	01	H2312_012_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	1	2		2	3							1			2																								
H2312	801	0	1	01	01	H2312_801_0	3		2																																																																																									
H2312	803	0	1	01	01	H2312_803_0	3		1																																																																																									
H2312	805	0	1	02	01	H2312_805_0	3		2																																																																																									
H2312	807	0	1	02	01	H2312_807_0	3		1																																																																																									
H2318	001	0	1	20	08	H2318_001_0	1		1																																																																																									
H2318	002	0	1	20	08	H2318_002_0	1		1																																																																																									
H2320	007	0	1	02	01	H2320_007_0	10	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	008	0	1	02	01	H2320_008_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	011	0	1	02	01	H2320_011_0	10	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	012	0	1	02	01	H2320_012_0	9	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	013	0	1	02	01	H2320_013_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	015	0	1	02	01	H2320_015_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	016	0	1	02	01	H2320_016_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	018	0	1	02	01	H2320_018_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	019	0	1	02	01	H2320_019_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	021	0	1	02	01	H2320_021_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H2320	802	0	1	02	01	H2320_802_0	5		1																																																																																									
H2320	803	0	1	02	01	H2320_803_0	5		1																																																																																									
H2320	804	0	1	01	01	H2320_804_0	5		1																																																																																									
H2320	805	0	1	01	01	H2320_805_0	5		1																																																																																									
H2322	004	0	1	04	01	H2322_004_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	011000	1				2	1	0100	1	2		1	3							1		011000	2																								
H2322	008	0	1	04	01	H2322_008_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	1	2		2	3							1			2																								
H2322	801	0	1	04	01	H2322_801_0	3		2																																																																																									
H2322	803	0	1	04	01	H2322_803_0	3		1																																																																																									
H2323	005	0	1	01	01	H2323_005_0	7		1	1	110110	2	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H2323	011	0	1	01	01	H2323_011_0	7		1	1	110110	2	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H2323	012	0	1	01	01	H2323_012_0	6		1	1	110110	2	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H2323	015	0	1	01	01	H2323_015_0	3	4A	1	4	110110	1	1	2	2	1	1	1	2			4	4			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2323	016	0	1	01	01	H2323_016_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	4			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H2354	001	0	1	02	01	H2354_001_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2354	013	0	1	02	01	H2354_013_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H2354	015	0	1	02	01	H2354_015_0	6	4A	1	3	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1							3							1			2																								
H2354	016	0	1	01	01	H2354_016_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H2354	801	0	1	02	01	H2354_801_0	3		2																																																																																									
H2354	802	0	1	02	01	H2354_802_0	4		1																																																																																									
H2354	805	0	1	02	01	H2354_805_0	4		1																																																																																									
H2386	001	0	1	20	08	H2386_001_0	1		1																																																																																									
H2386	002	0	1	20	08	H2386_002_0	1		1																																																																																									
H2406	001	0	1	04	01	H2406_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H2411	803	0	1	04	01	H2411_803_0	4		1																																																																																									
H2416	001	0	1	01	01	H2416_001_0	5		1	1	110100	1	1	2		1	1	1	2																																																										010	30							01	30										1	31	
H2417	001	0	1	01	01	H2417_001_0	3		1	1	110110	2	1	2		1	1	1	2																																																										110	31		93					01	31		110	31		93					1	31	2
H2419	001	0	1	01	01	H2419_001_0	6		1	1	110100	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30										1	31	1
H2422	002	0	1	01	01	H2422_002_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	1
H2425	001	0	1	01	01	H2425_001_0	6		1	1	110100	1	1	2		1	1	1	2																																																										010	34							01	34										1	34	
H2425	002	0	1	02	01	H2425_002_0	6	4C	1	3	110110	1	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		2	160.00	1						2							3							1			2																								
H2425	801	0	1	02	01	H2425_801_0	2		1																																																																																									
H2450	001	0	1	18	06	H2450_001_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2450	002	0	1	18	06	H2450_002_0	8	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2450	007	0	1	18	06	H2450_007_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	31		93					01	31		100			93					1	31	1
H2450	016	0	1	18	06	H2450_016_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	31		93					01	31		100			93					1	31	1
H2450	017	0	1	18	06	H2450_017_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	31		93					01	31		100			93					1	31	1
H2450	022	0	1	18	06	H2450_022_0	4		1	1	110110	1	1	2		1	1	1	2																																																										110	31		93					01	31		100			93					1	31	1
H2450	023	0	1	18	06	H2450_023_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2450	801	0		18	06	H2450_801_0	2		1																																																																																									
H2456	002	0	1	01	01	H2456_002_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					10		29	100			90					1	31	2
H2457	002	0	1	01	01	H2457_002_0	4		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H2458	002	0	1	01	01	H2458_002_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	31		93					01	31		100			93					1	31	1
H2459	001	0	1	02	01	H2459_001_0	7		2																																																																																									
H2459	002	0	1	02	01	H2459_002_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011000	2																								
H2459	013	0	1	02	01	H2459_013_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H2459	019	0	1	02	01	H2459_019_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H2459	801	0	1	02	01	H2459_801_0	6		1																																																																																									
H2459	805	0	1	02	01	H2459_805_0	3		2																																																																																									
H2461	005	0	1	18	06	H2461_005_0	3		2																																																																																									
H2461	006	0	1	18	06	H2461_006_0	4		2																																																																																									
H2461	007	0	1	18	06	H2461_007_0	3		2																																																																																									
H2462	004	0	1	18	06	H2462_004_0	2		2																																																																																									
H2462	007	0	1	18	06	H2462_007_0	5		2																																																																																									
H2462	008	0	1	18	06	H2462_008_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	125.00	2	000001	1				2	1	0100	2			2	3							1			2																								
H2462	010	0	1	18	06	H2462_010_0	4		2																																																																																									
H2462	011	0	1	18	06	H2462_011_0	6	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	175.00	2	000001	1				2							3							1			2																								
H2462	012	0	1	18	06	H2462_012_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	000001	1				2	1	0100	2			1	3							1		011100	2																								
H2462	015	0	1	18	06	H2462_015_0	5		2																																																																																									
H2462	016	0	1	18	06	H2462_016_0	4		2																																																																																									
H2462	017	0	1	18	06	H2462_017_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	1
H2462	018	0	1	18	06	H2462_018_0	4		2																																																																																									
H2462	019	0	1	18	06	H2462_019_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	175.00	2	000001	1				2	1	0100	2			2	3							1			2																								
H2462	801	0		18	06	H2462_801_0	1		1																																																																																									
H2462	802	0		18	06	H2462_802_0	1		1																																																																																									
H2486	003	0	1	01	01	H2486_003_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2486	801	0	1	01	01	H2486_801_0	2		1																																																																																									
H2486	802	0	1	01	01	H2486_802_0	2		2																																																																																									
H2486	803	0	1	01	01	H2486_803_0	2		1																																																																																									
H2491	002	0	1	02	01	H2491_002_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2491	004	0	1	02	01	H2491_004_0	4	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H2506	001	0	1	48	05	H2506_001_0	6	MM_5E	1	4	110110	1	1		2	1	1	1	2			5	2																				5				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs		3								3	1	1111				1			1			2		3		011111			1																						
H2531	001	0	1	48	05	H2531_001_0	4	MM_3A	1	4	110110	1	1		2	1	1	1	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011100			1																						
H2537	001	0	1	20	08	H2537_001_0	1		1																																																																																									
H2537	002	0	1	20	08	H2537_002_0	1		1																																																																																									
H2542	001	0	1	04	01	H2542_001_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2542	002	0	1	04	01	H2542_002_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2542	003	0	1	04	01	H2542_003_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2542	004	0	1	04	01	H2542_004_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2563	001	0	1	01	01	H2563_001_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2563	002	0	1	01	01	H2563_002_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2593	001	0	1	01	01	H2593_001_0	10	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H2593	003	0	1	01	01	H2593_003_0	8	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H2593	005	0	1	01	01	H2593_005_0	8	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H2593	006	0	1	01	01	H2593_006_0	12	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H2593	007	0	1	01	01	H2593_007_0	7	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H2593	011	0	1	01	01	H2593_011_0	7	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H2593	013	0	1	01	01	H2593_013_0	5	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H2593	014	0	1	01	01	H2593_014_0	5	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H2593	015	0	1	01	01	H2593_015_0	5	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H2593	016	0	1	01	01	H2593_016_0	7	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H2593	018	0	1	01	01	H2593_018_0	6	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H2593	801	0	1	01	01	H2593_801_0	4		2																																																																																									
H2593	802	0	1	01	01	H2593_802_0	4		1																																																																																									
H2593	804	0	1	01	01	H2593_804_0	4		1																																																																																									
H2609	001	0	1	20	08	H2609_001_0	2		1																																																																																									
H2609	002	0	1	20	08	H2609_002_0	2		1																																																																																									
H2610	005	0	1	01	01	H2610_005_0	6	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2610	006	0	1	01	01	H2610_006_0	5	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H2610	011	0	1	01	01	H2610_011_0	5	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2610	014	0	1	02	01	H2610_014_0	6	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2610	803	0	1	01	01	H2610_803_0	2		1																																																																																									
H2610	804	0	1	01	01	H2610_804_0	2		1																																																																																									
H2611	001	0	1	04	01	H2611_001_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2611	008	0	1	04	01	H2611_008_0	10	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2611	018	0	1	04	01	H2611_018_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2611	807	0	1	04	01	H2611_807_0	6		1																																																																																									
H2611	809	0	1	04	01	H2611_809_0	5		1																																																																																									
H2611	823	0	1	04	01	H2611_823_0	6		1																																																																																									
H2611	824	0	1	04	01	H2611_824_0	5		2																																																																																									
H2643	001	0	1	01	01	H2643_001_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H2649	004	0	1	01	01	H2649_004_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	012	0	1	01	01	H2649_012_0	3		2																																																																																									
H2649	020	0	1	01	01	H2649_020_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	021	0	1	02	01	H2649_021_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	022	0	1	01	01	H2649_022_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	023	0	1	01	01	H2649_023_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	024	0	1	01	01	H2649_024_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	175.00	2	011000	1				2	1	0110	2			1	3							1		001111	2																								
H2649	025	0	1	01	01	H2649_025_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	028	0	1	01	01	H2649_028_0	5		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H2649	029	0	1	01	01	H2649_029_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	030	0	1	02	01	H2649_030_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	031	0	1	01	01	H2649_031_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	032	0	1	01	01	H2649_032_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	033	0	1	01	01	H2649_033_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	034	0	1	01	01	H2649_034_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	035	0	1	01	01	H2649_035_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	036	0	1	01	01	H2649_036_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	037	0	1	01	01	H2649_037_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	038	0	1	01	01	H2649_038_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H2649	039	0	1	01	01	H2649_039_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H2649	040	0	1	01	01	H2649_040_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H2649	041	0	1	01	01	H2649_041_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2649	801	0	1	01	01	H2649_801_0	3		1																																																																																									
H2649	802	0	1	01	01	H2649_802_0	2		2																																																																																									
H2649	803	0	1	01	01	H2649_803_0	2		1																																																																																									
H2649	807	0	1	01	01	H2649_807_0	3		1																																																																																									
H2649	808	0	1	01	01	H2649_808_0	3		2																																																																																									
H2649	809	0	1	01	01	H2649_809_0	3		1																																																																																									
H2654	004	0	1	01	01	H2654_004_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2654	010	0	1	01	01	H2654_010_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2654	013	0	1	02	01	H2654_013_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2654	020	0	1	01	01	H2654_020_0	2		2																																																																																									
H2654	801	0	1	01	01	H2654_801_0	2		1																																																																																									
H2654	802	0	1	01	01	H2654_802_0	2		2																																																																																									
H2654	803	0	1	01	01	H2654_803_0	2		1																																																																																									
H2654	804	0	1	01	01	H2654_804_0	2		2																																																																																									
H2654	805	0	1	01	01	H2654_805_0	2		1																																																																																									
H2654	807	0	1	01	01	H2654_807_0	2		1																																																																																									
H2663	002	0	1	02	01	H2663_002_0	11	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2663	005	0	1	01	01	H2663_005_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2663	006	0	1	01	01	H2663_006_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2663	014	0	1	01	01	H2663_014_0	8		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	2
H2663	015	0	1	02	01	H2663_015_0	10	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H2663	802	0	1	01	01	H2663_802_0	5		1																																																																																									
H2663	804	0	1	01	01	H2663_804_0	5		1																																																																																									
H2663	805	0	1	01	01	H2663_805_0	5		2																																																																																									
H2667	001	0	1	01	01	H2667_001_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2667	012	0	1	01	01	H2667_012_0	3		2																																																																																									
H2667	017	0	1	02	01	H2667_017_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2667	018	0	1	01	01	H2667_018_0	5		1	1	110110	1	1	2		1	1	1	1	1	1																																																								111	30	60	90					01	30		111	30	60	90					1	31	2
H2667	803	0	1	01	01	H2667_803_0	5		1																																																																																									
H2667	807	0	1	01	01	H2667_807_0	5		1																																																																																									
H2667	808	0	1	01	01	H2667_808_0	3		2																																																																																									
H2672	001	0	1	01	01	H2672_001_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2672	008	0	1	01	01	H2672_008_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2672	009	0	1	01	01	H2672_009_0	4	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2672	010	0	1	01	01	H2672_010_0	5	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2672	011	0	1	01	01	H2672_011_0	4		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	2
H2672	012	0	1	01	01	H2672_012_0	4	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2672	801	0	1	01	01	H2672_801_0	2		1																																																																																									
H2672	802	0	1	01	01	H2672_802_0	2		1																																																																																									
H2672	803	0	1	01	01	H2672_803_0	2		2																																																																																									
H2676	001	0	1	04	01	H2676_001_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H2701	001	0	1	04	01	H2701_001_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H2701	003	0	1	04	01	H2701_003_0	10	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2701	004	0	1	04	01	H2701_004_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2701	005	0	1	04	01	H2701_005_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2701	006	0	1	04	01	H2701_006_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2701	806	0	1	04	01	H2701_806_0	2		1																																																																																									
H2701	807	0	1	04	01	H2701_807_0	2		1																																																																																									
H2758	002	0	1	01	01	H2758_002_0	8	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H2773	003	0	1	01	01	H2773_003_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H2773	013	0	1	01	01	H2773_013_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H2773	015	0	1	01	01	H2773_015_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H2773	017	0	1	01	01	H2773_017_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H2773	018	0	1	01	01	H2773_018_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H2773	019	0	1	01	01	H2773_019_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H2775	082	0	1	04	01	H2775_082_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2775	083	0	1	04	01	H2775_083_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2775	084	0	1	04	01	H2775_084_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2775	085	0	1	04	01	H2775_085_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2775	088	0	1	04	01	H2775_088_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2775	089	0	1	04	01	H2775_089_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2775	091	0	1	04	01	H2775_091_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2775	094	0	1	04	01	H2775_094_0	5		2																																																																																									
H2775	095	0	1	04	01	H2775_095_0	4		2																																																																																									
H2775	096	0	1	04	01	H2775_096_0	3		2																																																																																									
H2775	097	0	1	04	01	H2775_097_0	4		2																																																																																									
H2775	098	0	1	04	01	H2775_098_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2775	801	0	1	04	01	H2775_801_0	2		2																																																																																									
H2775	802	0	1	04	01	H2775_802_0	2		1																																																																																									
H2775	803	0	1	04	01	H2775_803_0	2		1																																																																																									
H2792	001	0	1	07	02	H2792_001_0	2		2																																																																																									
H2792	801	0	1	07	02	H2792_801_0	2		2																																																																																									
H2802	001	0	1	01	01	H2802_001_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2810	001	0	1	04	01	H2810_001_0	6	4C	1	3	110110	2	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		1		1						1							3							1			2																								
H2815	001	0	1	20	08	H2815_001_0	1		1																																																																																									
H2815	002	0	1	20	08	H2815_002_0	1		1																																																																																									
H2816	001	0	1	09	04	H2816_001_0	4		2																																																																																									
H2816	002	0	1	09	04	H2816_002_0	4		2																																																																																									
H2816	007	0	1	09	04	H2816_007_0	4		2																																																																																									
H2816	008	0	1	09	04	H2816_008_0	5		2																																																																																									
H2816	009	0	1	09	04	H2816_009_0	4		2																																																																																									
H2816	010	0	1	09	04	H2816_010_0	4		2																																																																																									
H2816	013	0	1	09	04	H2816_013_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2816	019	0	1	09	04	H2816_019_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2816	021	0	1	09	04	H2816_021_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2816	022	0	1	09	04	H2816_022_0	6	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	120.00	1						1							3							1			2																								
H2816	025	0	1	09	04	H2816_025_0	3		2																																																																																									
H2816	026	0	1	09	04	H2816_026_0	3		2																																																																																									
H2816	027	0	1	09	04	H2816_027_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2816	028	0	1	09	04	H2816_028_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H2816	801	0	1	09	04	H2816_801_0	1		2																																																																																									
H2816	802	0	1	09	04	H2816_802_0	1		1																																																																																									
H2816	803	0	1	09	04	H2816_803_0	1		1																																																																																									
H2836	001	0	1	04	01	H2836_001_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	180.00	2	110001	1				2							3							1			2																								
H2836	801	0	1	04	01	H2836_801_0	3		1																																																																																									
H2836	802	0	1	04	01	H2836_802_0	3		2																																																																																									
H2836	803	0	1	04	01	H2836_803_0	3		1																																																																																									
H2879	001	0	1	01	01	H2879_001_0	7		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H2905	001	0	1	04	01	H2905_001_0	8	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H2906	003	0	1	04	01	H2906_003_0	8	5A6	1	4	110110	1	1	1	1	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	0110	2			1	3							1		111100	2																								
H2906	005	0	1	04	01	H2906_005_0	8	5A6	1	4	110110	1	1	1	1	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	0110	2			1	3							1		011000	2																								
H2906	006	0	1	04	01	H2906_006_0	8	5A6	1	4	110110	1	1	1	1	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	0110	2			1	3							1		011000	2																								
H2906	007	0	1	04	01	H2906_007_0	6	5A6	1	4	110110	1	1	1	1	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	0110	2			1	3							1		011000	2																								
H2906	008	0	1	04	01	H2906_008_0	4		2																																																																																									
H2906	801	0	1	04	01	H2906_801_0	4		1																																																																																									
H2911	001	0	1	02	01	H2911_001_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011100	1				2	1	0110	2			2	3							1			2																								
H2926	001	0	1	01	01	H2926_001_0	3		1	1	110100	1	1	2		1	1	1	2																																																										010	30							01	30										1	31	
H2931	002	0	1	01	01	H2931_002_0	8	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H2931	004	0	1	01	01	H2931_004_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H2931	801	0	1	01	01	H2931_801_0	2		1																																																																																									
H2931	803	0	1	01	01	H2931_803_0	2		2																																																																																									
H2931	804	0	1	01	01	H2931_804_0	2		1																																																																																									
H2936	001	0	1	20	08	H2936_001_0	1		1																																																																																									
H2936	002	0	1	20	08	H2936_002_0	1		1																																																																																									
H2937	001	0	1	20	08	H2937_001_0	2		1																																																																																									
H2937	002	0	1	20	08	H2937_002_0	2		1																																																																																									
H2941	001	0	1	20	08	H2941_001_0	1		1																																																																																									
H2941	002	0	1	20	08	H2941_002_0	1		1																																																																																									
H2944	004	0	1	09	04	H2944_004_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011000	1				2							3							1			2																								
H2944	013	0	1	09	04	H2944_013_0	9	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2944	024	0	1	09	04	H2944_024_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2944	041	0	1	09	04	H2944_041_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2944	052	0	1	09	04	H2944_052_0	7		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H2944	078	0	1	09	04	H2944_078_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2944	085	0	1	09	04	H2944_085_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011100	1				2							3							1			2																								
H2944	106	0	1	09	04	H2944_106_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H2944	114	0	1	09	04	H2944_114_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	011100	1				2							3							1			2																								
H2944	124	0	1	09	04	H2944_124_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2944	127	0	1	09	04	H2944_127_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2944	128	0	1	09	04	H2944_128_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2944	133	0	1	09	04	H2944_133_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2944	197	0	1	09	04	H2944_197_0	4		2																																																																																									
H2949	009	0	1	01	01	H2949_009_0	4		2																																																																																									
H2949	012	0	1	01	01	H2949_012_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2949	013	0	1	01	01	H2949_013_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2949	014	0	1	01	01	H2949_014_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H2949	805	0	1	01	01	H2949_805_0	3		1																																																																																									
H2949	807	0	1	01	01	H2949_807_0	2		2																																																																																									
H2949	808	0	1	01	01	H2949_808_0	2		1																																																																																									
H2960	004	0	1	01	01	H2960_004_0	9	5A6	1	4	110110	1	1	1	1	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	0110	2			1	3							1		011000	2																								
H2960	009	0	1	01	01	H2960_009_0	7		2																																																																																									
H2960	010	0	1	01	01	H2960_010_0	9	5A6	1	4	110110	1	1	1	1	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	0110	2			1	3							1		111100	2																								
H2960	012	0	1	01	01	H2960_012_0	9	5A6	1	4	110110	1	1	1	1	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	0110	2			1	3							1		011000	2																								
H2960	018	0	1	01	01	H2960_018_0	9	5A6	1	4	110110	1	1	1	1	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								1	1	0110	2			1	3							1		011000	2																								
H2960	803	0	1	01	01	H2960_803_0	4		1																																																																																									
H2962	001	0	1	01	01	H2962_001_0	10	4B	1	4	110110	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H2962	002	0	1	01	01	H2962_002_0	10	4B	1	4	110110	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H2992	001	0	1	20	08	H2992_001_0	3		1																																																																																									
H2992	002	0	1	20	08	H2992_002_0	3		1																																																																																									
H2992	003	0	1	20	08	H2992_003_0	2		1																																																																																									
H2992	004	0	1	20	08	H2992_004_0	2		1																																																																																									
H3054	001	0	1	01	01	H3054_001_0	10		1	1	110110	1	1	2		1	1	2	2																																																										111	31	62	90					01	31		111	31	62	90					1	31	1
H3054	002	0	1	01	01	H3054_002_0	11	5A	1	4	110110	1	1	2	2	1	1	2	2			5	2				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	1	1	420.00	1	3							1		011000	2																								
H3060	001	0	1	20	08	H3060_001_0	1		1																																																																																									
H3060	002	0	1	20	08	H3060_002_0	1		1																																																																																									
H3067	001	0	1	48	05	H3067_001_0	12	MM_3A	1	4	110110	1	1		2	1	1	1	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011100			2																						
H3071	001	0	1	01	01	H3071_001_0	4		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	2
H3071	002	0	1	01	01	H3071_002_0	10	2A	1	4	110110	1	1	2	2	1	1	1	2			2	2	1																							Generic, Brand		1		1						1	1	0010	2			2	3							1			2																								
H3107	004	0	1	01	01	H3107_004_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3107	008	0	1	01	01	H3107_008_0	3		2																																																																																									
H3107	012	0	1	01	01	H3107_012_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3107	801	0	1	01	01	H3107_801_0	2		1																																																																																									
H3107	803	0	1	01	01	H3107_803_0	2		2																																																																																									
H3107	804	0	1	01	01	H3107_804_0	2		1																																																																																									
H3107	807	0	1	02	01	H3107_807_0	2		1																																																																																									
H3113	001	0	1	01	01	H3113_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3132	001	0	1	01	01	H3132_001_0	5	3F	1	2	110100	1	1	2		1	1	1	2			3	3		6																				1	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
H3144	001	0	1	01	01	H3144_001_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3144	002	0	1	01	01	H3144_002_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3144	003	0	1	01	01	H3144_003_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3144	801	0	1	01	01	H3144_801_0	4		1																																																																																									
H3144	802	0	1	01	01	H3144_802_0	4		1																																																																																									
H3144	803	0	1	01	01	H3144_803_0	4		2																																																																																									
H3152	022	0	1	01	01	H3152_022_0	6	4A7	1	3	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1		1						3							3							1			2																								
H3152	045	0	1	01	01	H3152_045_0	4		2																																																																																									
H3152	046	0	1	01	01	H3152_046_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3152	048	0	1	01	01	H3152_048_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3152	077	0	1	01	01	H3152_077_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3152	801	0	1	01	01	H3152_801_0	1		2																																																																																									
H3152	804	0	1	01	01	H3152_804_0	1		1																																																																																									
H3154	004	0	1	01	01	H3154_004_0	10	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H3154	013	0	1	01	01	H3154_013_0	6		2																																																																																									
H3154	020	0	1	01	01	H3154_020_0	10		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H3154	022	0	1	01	01	H3154_022_0	8	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H3154	801	0	1	02	01	H3154_801_0	5		2																																																																																									
H3154	802	0	1	02	01	H3154_802_0	5		1																																																																																									
H3154	805	0	1	02	01	H3154_805_0	6		1																																																																																									
H3156	029	0	1	01	01	H3156_029_0	6		2																																																																																									
H3156	030	0	1	01	01	H3156_030_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	295.00	2	011000	1				1	1	0110	2			2	3							1			2																								
H3156	032	0	1	01	01	H3156_032_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	295.00	2	011000	1				1	1	0110	2			2	3							1			2																								
H3156	033	0	1	01	01	H3156_033_0	6		2																																																																																									
H3156	034	0	1	01	01	H3156_034_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	295.00	2	011000	1				1	1	0110	2			2	3							1			2																								
H3156	801	0	1	01	01	H3156_801_0	3		2																																																																																									
H3156	803	0	1	01	01	H3156_803_0	3		1																																																																																									
H3204	001	0	1	01	01	H3204_001_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3204	007	0	1	01	01	H3204_007_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H3204	008	0	1	01	01	H3204_008_0	6		2																																																																																									
H3204	801	0	1	01	01	H3204_801_0	4		1																																																																																									
H3204	802	0	1	01	01	H3204_802_0	4		2																																																																																									
H3204	803	0	1	01	01	H3204_803_0	4		1																																																																																									
H3206	001	0	1	04	01	H3206_001_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3206	002	0	1	04	01	H3206_002_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H3206	003	0	1	04	01	H3206_003_0	6		2																																																																																									
H3206	801	0	1	04	01	H3206_801_0	4		1																																																																																									
H3206	802	0	1	04	01	H3206_802_0	4		2																																																																																									
H3206	803	0	1	04	01	H3206_803_0	4		1																																																																																									
H3209	001	0	1	04	01	H3209_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3209	002	0	1	04	01	H3209_002_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3237	001	0	1	48	05	H3237_001_0	5	MM_3A	1	4	110110	1	1		2	1	1	1	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011100			2																						
H3237	002	0	1	48	05	H3237_002_0	4	MM_3A	1	4	110110	1	1		2	1	1	1	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011100			2																						
H3240	013	0	1	01	01	H3240_013_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	31	62	93					01	31		111	31	62	93					1	31	2
H3251	002	0	1	01	01	H3251_002_0	10	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0100	2			1	3							1		011000	2																								
H3251	021	0	1	02	01	H3251_021_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0100	2			1	3							2	3500.00	011000	2																								
H3251	024	0	1	01	01	H3251_024_0	12	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0100	2			1	3							1		011000	2																								
H3251	027	0	1	01	01	H3251_027_0	7	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H3251	804	0	1	01	01	H3251_804_0	1		1																																																																																									
H3259	001	0	1	01	01	H3259_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	1
H3283	003	0	1	04	01	H3283_003_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	31		93					01	31		100			93					1	31	1
H3305	007	0	1	02	01	H3305_007_0	4		2																																																																																									
H3305	011	0	1	02	01	H3305_011_0	7	4B7	1	4	110110	1	1	2	2	1	1	1	2			5	3				2		9																		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		000001	2																								
H3305	015	0	1	02	01	H3305_015_0	7	4B7	1	4	110110	1	1	2	2	1	1	1	2			5	3				2		9																		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		000001	2																								
H3305	801	0	1	02	01	H3305_801_0	2		2																																																																																									
H3305	803	0	1	02	01	H3305_803_0	2		1																																																																																									
H3307	002	0	1	01	01	H3307_002_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3307	012	0	1	01	01	H3307_012_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3307	015	0	1	01	01	H3307_015_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3307	018	0	1	01	01	H3307_018_0	3		2																																																																																									
H3307	802	0	1	01	01	H3307_802_0	2		1																																																																																									
H3307	804	0	1	01	01	H3307_804_0	2		2																																																																																									
H3307	805	0	1	01	01	H3307_805_0	2		1																																																																																									
H3307	807	0	1	02	01	H3307_807_0	2		1																																																																																									
H3312	002	0	1	01	01	H3312_002_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3312	018	0	1	01	01	H3312_018_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3312	048	0	1	01	01	H3312_048_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3312	060	0	1	01	01	H3312_060_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3312	061	0	1	01	01	H3312_061_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3312	801	0	1	01	01	H3312_801_0	1		2																																																																																									
H3312	804	0	1	01	01	H3312_804_0	1		1																																																																																									
H3321	001	0	1	20	08	H3321_001_0	1		1																																																																																									
H3321	003	0	1	20	08	H3321_003_0	1		1																																																																																									
H3322	001	0	1	20	08	H3322_001_0	1		1																																																																																									
H3322	002	0	1	20	08	H3322_002_0	1		1																																																																																									
H3327	001	0	1	01	01	H3327_001_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3327	002	0	1	01	01	H3327_002_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3327	026	0	1	01	01	H3327_026_0	4		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H3327	038	0	1	02	01	H3327_038_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3327	039	0	1	02	01	H3327_039_0	3		2																																																																																									
H3327	040	0	1	01	01	H3327_040_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3327	041	0	1	01	01	H3327_041_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3327	042	0	1	01	01	H3327_042_0	4		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H3327	043	0	1	01	01	H3327_043_0	4		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H3327	044	0	1	01	01	H3327_044_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H3327	801	0	1	01	01	H3327_801_0	3		1																																																																																									
H3327	802	0	1	01	01	H3327_802_0	3		2																																																																																									
H3327	803	0	1	01	01	H3327_803_0	3		1																																																																																									
H3328	001	0	1	02	01	H3328_001_0	7		2																																																																																									
H3328	002	0	1	01	01	H3328_002_0	6	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H3328	003	0	1	02	01	H3328_003_0	10	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	240.00	2	011000	1				2							3							1			2																								
H3328	016	0	1	01	01	H3328_016_0	6	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H3328	017	0	1	01	01	H3328_017_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	2		2			1	3							1		010000	2																								
H3328	018	0	1	01	01	H3328_018_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	34	1
H3328	019	0	1	01	01	H3328_019_0	10	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							2	2540.00		2																								
H3328	801	0	1	02	01	H3328_801_0	7		2																																																																																									
H3328	802	0	1	02	01	H3328_802_0	7		1																																																																																									
H3328	803	0	1	02	01	H3328_803_0	6		1																																																																																									
H3329	001	0	1	20	08	H3329_001_0	1		1																																																																																									
H3329	002	0	1	20	08	H3329_002_0	1		1																																																																																									
H3330	021	1	1	01	01	H3330_021_1	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3330	021	2	1	01	01	H3330_021_2	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3330	021	3	1	01	01	H3330_021_3	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3330	029	0	1	01	01	H3330_029_0	9	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H3330	032	1	1	01	01	H3330_032_1	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3330	032	2	1	01	01	H3330_032_2	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3330	032	3	1	01	01	H3330_032_3	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3330	033	1	1	01	01	H3330_033_1	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3330	033	2	1	01	01	H3330_033_2	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3330	033	3	1	01	01	H3330_033_3	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3330	808	0	2	01	01	H3330_808_0	4		1																																																																																									
H3330	810	0	1	01	01	H3330_810_0	4		1																																																																																									
H3330	814	0	1	01	01	H3330_814_0	4		1																																																																																									
H3330	815	0	1	01	01	H3330_815_0	4		2																																																																																									
H3330	817	0	1	01	01	H3330_817_0	5		1																																																																																									
H3331	001	0	1	20	08	H3331_001_0	1		1																																																																																									
H3331	002	0	1	20	08	H3331_002_0	1		1																																																																																									
H3333	037	0	1	09	04	H3333_037_0	4		2																																																																																									
H3333	039	0	1	09	04	H3333_039_0	4		2																																																																																									
H3333	055	0	1	09	04	H3333_055_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H3333	057	0	1	09	04	H3333_057_0	6	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	130.00	1						1							3							1			2																								
H3333	163	0	1	09	04	H3333_163_0	5		2																																																																																									
H3333	164	0	1	09	04	H3333_164_0	4		2																																																																																									
H3333	165	0	1	09	04	H3333_165_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H3333	166	0	1	09	04	H3333_166_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H3335	002	0	1	04	01	H3335_002_0	6	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	005	0	1	04	01	H3335_005_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	006	0	1	04	01	H3335_006_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	008	0	1	04	01	H3335_008_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	009	0	1	04	01	H3335_009_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	014	0	1	04	01	H3335_014_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	015	0	1	04	01	H3335_015_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	018	0	1	04	01	H3335_018_0	8	4A	1	3	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	225.00	1						2							3							1			2																								
H3335	021	0	1	04	01	H3335_021_0	8	4A	1	3	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	225.00	1						2							3							1			2																								
H3335	032	0	1	04	01	H3335_032_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	037	0	1	04	01	H3335_037_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	038	0	1	04	01	H3335_038_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	041	0	1	04	01	H3335_041_0	6		2																																																																																									
H3335	042	0	1	04	01	H3335_042_0	6		2																																																																																									
H3335	043	0	1	04	01	H3335_043_0	6		2																																																																																									
H3335	044	0	1	04	01	H3335_044_0	6		2																																																																																									
H3335	045	0	1	04	01	H3335_045_0	6		2																																																																																									
H3335	051	0	1	04	01	H3335_051_0	7	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3335	801	0	1	04	01	H3335_801_0	3		1																																																																																									
H3335	811	0	1	04	01	H3335_811_0	4		1																																																																																									
H3335	813	0	1	04	01	H3335_813_0	3		2																																																																																									
H3335	819	0	1	04	01	H3335_819_0	4		2																																																																																									
H3335	820	0	1	04	01	H3335_820_0	4		1																																																																																									
H3335	822	0	1	04	01	H3335_822_0	3		1																																																																																									
H3337	001	0	1	01	01	H3337_001_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H3337	003	0	1	01	01	H3337_003_0	6		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H3342	001	0	1	04	01	H3342_001_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3342	012	0	1	04	01	H3342_012_0	6	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	125.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H3342	013	0	1	04	01	H3342_013_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	100.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H3342	014	0	1	04	01	H3342_014_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	90.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H3342	808	0	1	04	01	H3342_808_0	2		1																																																																																									
H3342	809	0	1	04	01	H3342_809_0	2		2																																																																																									
H3342	810	0	1	04	01	H3342_810_0	2		1																																																																																									
H3344	005	0	1	04	01	H3344_005_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	1	2		1	3							1		011000	2																								
H3344	801	0	1	04	01	H3344_801_0	2		1																																																																																									
H3344	803	0	1	04	01	H3344_803_0	2		1																																																																																									
H3344	804	0	1	04	01	H3344_804_0	2		2																																																																																									
H3347	002	0	1	01	01	H3347_002_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H3347	003	0	1	01	01	H3347_003_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3347	005	0	1	01	01	H3347_005_0	10	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H3347	007	0	1	01	01	H3347_007_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H3347	008	0	1	01	01	H3347_008_0	11		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H3347	009	0	1	01	01	H3347_009_0	15		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H3351	001	0	1	02	01	H3351_001_0	5		2																																																																																									
H3351	002	0	1	02	01	H3351_002_0	6	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3351	006	0	1	02	01	H3351_006_0	6	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3351	007	0	1	02	01	H3351_007_0	5		2																																																																																									
H3351	010	0	1	01	01	H3351_010_0	6	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3351	011	0	1	01	01	H3351_011_0	6	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3351	012	0	1	01	01	H3351_012_0	6	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3351	013	0	1	01	01	H3351_013_0	6	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3351	801	0	1	02	01	H3351_801_0	4		1																																																																																									
H3351	802	0	1	02	01	H3351_802_0	3		1																																																																																									
H3351	803	0	1	02	01	H3351_803_0	3		2																																																																																									
H3351	804	0	1	02	01	H3351_804_0	3		2																																																																																									
H3351	805	0	1	02	01	H3351_805_0	4		1																																																																																									
H3351	806	0	1	02	01	H3351_806_0	4		1																																																																																									
H3359	001	0	1	01	01	H3359_001_0	12	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							2	2800.00		2																								
H3359	019	0	1	01	01	H3359_019_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3359	021	0	1	01	01	H3359_021_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3359	027	0	1	01	01	H3359_027_0	6		2																																																																																									
H3359	033	0	1	01	01	H3359_033_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3359	034	0	1	01	01	H3359_034_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3359	035	0	1	01	01	H3359_035_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3361	043	0	1	01	01	H3361_043_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H3361	059	0	1	01	01	H3361_059_0	4		2																																																																																									
H3361	065	0	1	01	01	H3361_065_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H3361	098	0	1	01	01	H3361_098_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H3361	099	0	1	02	01	H3361_099_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3361	106	0	1	02	01	H3361_106_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3361	109	0	1	01	01	H3361_109_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H3361	130	0	1	01	01	H3361_130_0	6	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H3361	132	0	1	02	01	H3361_132_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3361	133	0	1	01	01	H3361_133_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3362	016	0	1	01	01	H3362_016_0	2		2																																																																																									
H3362	017	0	1	01	01	H3362_017_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	1	2		1	3							1		011000	2																								
H3362	020	0	1	01	01	H3362_020_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	1	2		1	3							1		011000	2																								
H3362	025	0	1	01	01	H3362_025_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	1	2		1	3							1		011000	2																								
H3362	026	0	1	02	01	H3362_026_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	1	2		1	3							1		011000	2																								
H3362	027	0	1	01	01	H3362_027_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	1	2		1	3							1		011000	2																								
H3362	801	0	1	01	01	H3362_801_0	1		1																																																																																									
H3362	807	0	1	02	01	H3362_807_0	3		1																																																																																									
H3362	817	0	1	02	01	H3362_817_0	2		1																																																																																									
H3362	819	0	1	02	01	H3362_819_0	3		2																																																																																									
H3362	820	0	1	01	01	H3362_820_0	1		2																																																																																									
H3370	001	0	1	01	01	H3370_001_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3370	002	0	1	01	01	H3370_002_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3370	003	0	1	01	01	H3370_003_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	100.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H3370	004	0	1	01	01	H3370_004_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3370	014	0	1	01	01	H3370_014_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3370	019	0	1	01	01	H3370_019_0	3		2																																																																																									
H3370	801	0	1	01	01	H3370_801_0	2		1																																																																																									
H3370	803	0	1	01	01	H3370_803_0	2		2																																																																																									
H3370	805	0	1	01	01	H3370_805_0	2		1																																																																																									
H3379	001	0	1	01	01	H3379_001_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3379	002	0	1	01	01	H3379_002_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3379	022	0	1	01	01	H3379_022_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3384	013	0	1	01	01	H3384_013_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H3384	019	0	1	01	01	H3384_019_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H3384	022	0	1	01	01	H3384_022_0	6		2																																																																																									
H3384	056	0	1	01	01	H3384_056_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H3384	057	0	1	02	01	H3384_057_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H3384	058	0	1	02	01	H3384_058_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H3384	059	0	1	02	01	H3384_059_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H3384	805	0	1	01	01	H3384_805_0	1		2																																																																																									
H3384	806	0	1	01	01	H3384_806_0	1		1																																																																																									
H3384	807	0	1	01	01	H3384_807_0	4		1																																																																																									
H3387	010	0	1	01	01	H3387_010_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3388	001	0	1	01	01	H3388_001_0	5		2																																																																																									
H3388	002	0	1	01	01	H3388_002_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H3388	004	0	1	01	01	H3388_004_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3388	801	0	1	01	01	H3388_801_0	6		1																																																																																									
H3388	803	0	1	01	01	H3388_803_0	5		1																																																																																									
H3388	804	0	1	01	01	H3388_804_0	5		2																																																																																									
H3404	001	0	1	04	01	H3404_001_0	7	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3404	002	0	1	04	01	H3404_002_0	8	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3404	801	0	1	04	01	H3404_801_0	1		2																																																																																									
H3404	803	0	1	04	01	H3404_803_0	1		1																																																																																									
H3405	001	0	1	04	01	H3405_001_0	9	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3405	002	0	1	04	01	H3405_002_0	9	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3405	005	0	1	04	01	H3405_005_0	10	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3405	007	0	1	04	01	H3405_007_0	10	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3405	008	0	1	04	01	H3405_008_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3421	001	0	1	09	04	H3421_001_0	4		2																																																																																									
H3421	002	0	1	09	04	H3421_002_0	5	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H3430	001	0	1	20	08	H3430_001_0	1		1																																																																																									
H3430	002	0	1	20	08	H3430_002_0	1		1																																																																																									
H3447	001	0	1	01	01	H3447_001_0	8	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H3447	003	0	1	01	01	H3447_003_0	8	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H3447	004	0	1	01	01	H3447_004_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H3447	005	0	1	01	01	H3447_005_0	9	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H3447	008	0	1	01	01	H3447_008_0	7	5A7	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1		2	011000	1				1	1	0010	2			1	3							2	2425.00	011000	2																								
H3449	005	0	1	01	01	H3449_005_0	7	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3449	012	0	1	01	01	H3449_012_0	4		2																																																																																									
H3449	013	0	1	01	01	H3449_013_0	6	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3449	801	0	1	01	01	H3449_801_0	1		1																																																																																									
H3449	805	0	1	01	01	H3449_805_0	1		2																																																																																									
H3456	001	0	1	01	01	H3456_001_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H3456	010	0	1	01	01	H3456_010_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3456	016	0	1	01	01	H3456_016_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3456	020	0	1	01	01	H3456_020_0	2		2																																																																																									
H3456	023	0	1	01	01	H3456_023_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3456	801	0	1	01	01	H3456_801_0	2		1																																																																																									
H3456	803	0	1	01	01	H3456_803_0	2		1																																																																																									
H3456	804	0	1	01	01	H3456_804_0	2		2																																																																																									
H3456	805	0	2	01	01	H3456_805_0	2		1																																																																																									
H3456	806	0	2	01	01	H3456_806_0	2		1																																																																																									
H3456	808	0	1	02	01	H3456_808_0	2		1																																																																																									
H3471	001	0	1	01	01	H3471_001_0	6	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011000	1				1							3							1			2																								
H3471	002	0	1	01	01	H3471_002_0	6	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	011000	1				1							3							1			2																								
H3471	003	0	1	01	01	H3471_003_0	4		2																																																																																									
H3471	801	0	1	01	01	H3471_801_0	1		2																																																																																									
H3471	802	0	1	01	01	H3471_802_0	1		1																																																																																									
H3471	803	0	1	01	01	H3471_803_0	1		1																																																																																									
H3473	001	0	1	20	08	H3473_001_0	1		1																																																																																									
H3473	002	0	1	20	08	H3473_002_0	1		1																																																																																									
H3480	001	0	1	48	05	H3480_001_0	10	MM_4A	1	4	110110	1	1		2	1	1	1	2			4	2																			1					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011110			1																						
H3493	001	0	1	20	08	H3493_001_0	1		1																																																																																									
H3493	002	0	1	20	08	H3493_002_0	1		1																																																																																									
H3517	001	0	1	20	08	H3517_001_0	1		1																																																																																									
H3517	002	0	1	20	08	H3517_002_0	1		1																																																																																									
H3528	001	0	1	01	01	H3528_001_0	8	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3528	002	0	1	01	01	H3528_002_0	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H3528	003	0	1	01	01	H3528_003_0	4		2																																																																																									
H3528	006	0	1	02	01	H3528_006_0	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H3528	008	0	1	02	01	H3528_008_0	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3528	009	0	1	01	01	H3528_009_0	6	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3528	801	0	1	01	01	H3528_801_0	5		1																																																																																									
H3528	805	0	1	01	01	H3528_805_0	5		2																																																																																									
H3528	806	0	1	02	01	H3528_806_0	6		1																																																																																									
H3528	807	0	1	02	01	H3528_807_0	4		2																																																																																									
H3533	001	0	1	01	01	H3533_001_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H3533	002	0	1	01	01	H3533_002_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	010000	1				2							3							1			2																								
H3533	004	0	1	01	01	H3533_004_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	125.00	2	010000	1				2							3							1			2																								
H3533	005	0	1	01	01	H3533_005_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3533	006	0	1	01	01	H3533_006_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3533	007	0	1	01	01	H3533_007_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3533	008	0	1	01	01	H3533_008_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	110.00	2	011000	1				2							3							1			2																								
H3533	009	0	1	01	01	H3533_009_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3533	010	0	1	01	01	H3533_010_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H3533	802	0	1	01	01	H3533_802_0	2		1																																																																																									
H3533	803	0	1	01	01	H3533_803_0	2		2																																																																																									
H3533	804	0	1	01	01	H3533_804_0	2		1																																																																																									
H3536	001	0	1	01	01	H3536_001_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	100.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H3536	801	0	1	01	01	H3536_801_0	4		1																																																																																									
H3597	001	0	1	01	01	H3597_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3597	002	0	1	01	01	H3597_002_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3597	801	0	1	01	01	H3597_801_0	1		2																																																																																									
H3597	802	0	1	01	01	H3597_802_0	1		1																																																																																									
H3613	001	0	1	20	08	H3613_001_0	1		1																																																																																									
H3613	002	0	1	20	08	H3613_002_0	1		1																																																																																									
H3614	001	0	1	20	08	H3614_001_0	2		1																																																																																									
H3614	002	0	1	20	08	H3614_002_0	1		1																																																																																									
H3620	004	0	1	04	01	H3620_004_0	4	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H3620	801	0	1	04	01	H3620_801_0	4		1																																																																																									
H3620	802	0	1	04	01	H3620_802_0	5		2																																																																																									
H3620	803	0	1	04	01	H3620_803_0	4		1																																																																																									
H3620	805	0	2	04	01	H3620_805_0	4		1																																																																																									
H3620	806	0	2	04	01	H3620_806_0	4		2																																																																																									
H3623	001	0	1	01	01	H3623_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3623	003	0	1	01	01	H3623_003_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3623	004	0	1	01	01	H3623_004_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3623	018	0	1	01	01	H3623_018_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3623	019	0	1	01	01	H3623_019_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3623	020	0	1	01	01	H3623_020_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3623	801	0	1	01	01	H3623_801_0	1		2																																																																																									
H3623	802	0	1	01	01	H3623_802_0	1		1																																																																																									
H3653	004	0	1	01	01	H3653_004_0	8	5C	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	3				9																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3653	015	0	1	01	01	H3653_015_0	7	5C	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	3				9																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Injectable Drugs, Specialty Tier		2	100.00	2	011011	1				2	1	0110	2			2	3							1			2																								
H3653	018	0	1	01	01	H3653_018_0	4		2																																																																																									
H3653	803	0	1	01	01	H3653_803_0	2		2																																																																																									
H3653	806	0	2	01	01	H3653_806_0	3		2																																																																																									
H3653	809	0	1	01	01	H3653_809_0	3		1																																																																																									
H3655	013	0	1	01	01	H3655_013_0	6	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	60.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H3655	030	0	1	01	01	H3655_030_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	60.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H3655	801	0	1	01	01	H3655_801_0	3		1																																																																																									
H3655	803	0	1	01	01	H3655_803_0	3		2																																																																																									
H3655	804	0	1	01	01	H3655_804_0	3		1																																																																																									
H3659	001	0	1	01	01	H3659_001_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3659	003	0	1	01	01	H3659_003_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3659	031	0	1	01	01	H3659_031_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H3659	054	0	1	01	01	H3659_054_0	2		2																																																																																									
H3659	056	0	1	01	01	H3659_056_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3659	058	0	1	02	01	H3659_058_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3659	801	0	1	01	01	H3659_801_0	2		1																																																																																									
H3659	802	0	1	01	01	H3659_802_0	2		2																																																																																									
H3659	803	0	1	01	01	H3659_803_0	2		1																																																																																									
H3659	807	0	1	02	01	H3659_807_0	2		1																																																																																									
H3660	028	0	1	02	01	H3660_028_0	6	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3660	029	0	1	02	01	H3660_029_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3660	044	0	1	01	01	H3660_044_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3660	047	0	1	01	01	H3660_047_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3660	048	0	1	02	01	H3660_048_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3660	801	0	1	01	01	H3660_801_0	2		1																																																																																									
H3660	802	0	1	01	01	H3660_802_0	2		2																																																																																									
H3660	805	0	1	02	01	H3660_805_0	2		1																																																																																									
H3660	806	0	1	02	01	H3660_806_0	2		2																																																																																									
H3664	014	0	1	02	01	H3664_014_0	3		2																																																																																									
H3664	017	0	1	02	01	H3664_017_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3664	020	0	1	02	01	H3664_020_0	4	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H3664	801	0	1	02	01	H3664_801_0	4		1																																																																																									
H3664	802	0	1	02	01	H3664_802_0	4		2																																																																																									
H3664	803	0	1	02	01	H3664_803_0	4		1																																																																																									
H3664	805	0	2	02	01	H3664_805_0	4		1																																																																																									
H3664	806	0	2	02	01	H3664_806_0	4		2																																																																																									
H3668	005	0	1	01	01	H3668_005_0	4	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H3668	011	0	1	01	01	H3668_011_0	5	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3668	013	0	1	01	01	H3668_013_0	3		2																																																																																									
H3668	014	0	1	01	01	H3668_014_0	4	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H3668	015	0	1	01	01	H3668_015_0	6	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3668	016	0	1	01	01	H3668_016_0	4	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H3668	017	0	1	01	01	H3668_017_0	6	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3668	801	0	1	01	01	H3668_801_0	1		2																																																																																									
H3668	802	0	1	01	01	H3668_802_0	1		1																																																																																									
H3668	803	0	1	01	01	H3668_803_0	1		1																																																																																									
H3668	804	0	1	01	01	H3668_804_0	1		1																																																																																									
H3668	805	0	1	01	01	H3668_805_0	1		2																																																																																									
H3668	806	0	1	01	01	H3668_806_0	1		1																																																																																									
H3668	807	0	1	01	01	H3668_807_0	1		1																																																																																									
H3668	808	0	1	01	01	H3668_808_0	1		2																																																																																									
H3668	809	0	1	01	01	H3668_809_0	1		1																																																																																									
H3668	810	0	1	01	01	H3668_810_0	1		1																																																																																									
H3672	013	0	1	01	01	H3672_013_0	10	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H3672	014	0	1	01	01	H3672_014_0	8		2																																																																																									
H3672	016	0	1	01	01	H3672_016_0	10	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H3672	017	0	1	01	01	H3672_017_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H3672	018	0	1	01	01	H3672_018_0	12	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3672	804	0	1	01	01	H3672_804_0	3		2																																																																																									
H3672	805	0	1	01	01	H3672_805_0	4		1																																																																																									
H3706	001	0	1	01	01	H3706_001_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H3706	009	0	1	01	01	H3706_009_0	5		2																																																																																									
H3706	803	0	1	01	01	H3706_803_0	2		1																																																																																									
H3706	804	0	1	01	01	H3706_804_0	2		1																																																																																									
H3706	807	0	1	01	01	H3706_807_0	2		2																																																																																									
H3708	001	0	1	01	01	H3708_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	34	2
H3712	001	0	1	01	01	H3712_001_0	11	5A	1	4	110110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	3000.00	011110	2																								
H3712	002	0	1	01	01	H3712_002_0	10	5A	1	4	110110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	3000.00	010000	2																								
H3749	001	0	1	01	01	H3749_001_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3749	004	0	1	01	01	H3749_004_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3749	017	0	1	01	01	H3749_017_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3749	801	0	1	01	01	H3749_801_0	2		2																																																																																									
H3749	803	0	1	01	01	H3749_803_0	2		1																																																																																									
H3749	804	0	1	01	01	H3749_804_0	2		1																																																																																									
H3755	001	0	1	01	01	H3755_001_0	5	5A8	1	4	110110	1	1	2	2	1	1	1	2			6	3											1	2												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs		3								1	1	0100	2			2	3							1			2																								
H3755	002	0	1	01	01	H3755_002_0	3		2																																																																																									
H3755	004	0	1	01	01	H3755_004_0	7	5A8	1	4	110110	1	1	2	2	1	1	1	2			6	3											1	2												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs		3								1	1	0100	2			2	3							1			2																								
H3755	005	0	1	01	01	H3755_005_0	4	5A8	1	4	110110	1	1	2	2	1	1	1	2			6	3											1	2												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Injectable Drugs		3								1	1	0100	2			2	3							1			2																								
H3755	801	0	1	01	01	H3755_801_0	4		1																																																																																									
H3794	001	0	1	01	01	H3794_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3805	001	0	1	01	01	H3805_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3805	007	0	1	01	01	H3805_007_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3805	012	0	1	01	01	H3805_012_0	5	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H3805	013	0	1	01	01	H3805_013_0	5	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H3805	801	0	1	01	01	H3805_801_0	2		2																																																																																									
H3805	803	0	1	01	01	H3805_803_0	2		1																																																																																									
H3805	804	0	1	01	01	H3805_804_0	2		1																																																																																									
H3809	001	0	1	20	08	H3809_001_0	3		1																																																																																									
H3809	002	0	1	20	08	H3809_002_0	3		1																																																																																									
H3810	001	0	1	01	01	H3810_001_0	9		2																																																																																									
H3810	003	0	1	01	01	H3810_003_0	12	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3810	006	0	1	01	01	H3810_006_0	9		2																																																																																									
H3810	007	0	1	01	01	H3810_007_0	13	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3810	019	0	1	01	01	H3810_019_0	10		1	1	110110	1	1	1		1	1	1	1	1	1																																																								111	30	60	90					01	30		111	30	60	90					1	31	1
H3811	001	0	1	01	01	H3811_001_0	4		2																																																																																									
H3811	002	0	1	01	01	H3811_002_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3811	003	0	1	01	01	H3811_003_0	6		1	1	110110	1	1	2		1	1	1	2																																																										111	34	60	90					01	34		100			90					1	31	2
H3811	009	0	1	01	01	H3811_009_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H3812	001	0	1	04	01	H3812_001_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3812	005	0	1	04	01	H3812_005_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3813	001	0	1	04	01	H3813_001_0	3		2																																																																																									
H3813	004	0	1	04	01	H3813_004_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3813	005	0	1	04	01	H3813_005_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3813	006	0	1	04	01	H3813_006_0	3	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	120.00	1						2	1	0100	2			2	3							1			2																								
H3813	802	0	1	04	01	H3813_802_0	1		1																																																																																									
H3814	007	0	1	01	01	H3814_007_0	7		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	31		90					01	31		110	31		90					1	31	1
H3815	001	0	1	01	01	H3815_001_0	11	5D	1	4	110110	2	1	2	2	1	1	1	2			5	3				10																				Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								3	1	0110	1	1	36.00	2	3							1			2																								
H3815	006	0	1	01	01	H3815_006_0	11	5D	1	4	110110	2	1	2	2	1	1	1	2			5	3				10																				Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								3	1	0110	1	1	36.00	2	3							1			2																								
H3815	007	0	1	01	01	H3815_007_0	11	5D	1	4	110110	2	1	2	2	1	1	1	2			5	3				10																				Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								3	1	0110	1	1	36.00	2	3							1			2																								
H3817	001	0	1	04	01	H3817_001_0	7		2																																																																																									
H3817	002	0	1	04	01	H3817_002_0	15	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	205.00	1						1							3							1			2																								
H3817	003	0	1	04	01	H3817_003_0	11	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		010000	2																								
H3817	801	0	1	04	01	H3817_801_0	2		2																																																																																									
H3817	802	0	1	04	01	H3817_802_0	1		1																																																																																									
H3818	002	0	1	01	01	H3818_002_0	17		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					10		10	111	30	60	90					1	31	2
H3818	003	0	1	01	01	H3818_003_0	18	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	1						3							3							1			2																								
H3818	004	0	1	01	01	H3818_004_0	15		2																																																																																									
H3818	014	0	1	01	01	H3818_014_0	18	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	1						3	1	0110	2			2	3							1			2																								
H3822	001	0	1	01	01	H3822_001_0	14	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3822	002	0	1	01	01	H3822_002_0	12	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3822	003	0	1	01	01	H3822_003_0	11	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3822	004	0	1	01	01	H3822_004_0	13	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3822	005	0	1	02	01	H3822_005_0	12	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3822	006	0	1	01	01	H3822_006_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	1
H3822	007	0	1	02	01	H3822_007_0	14	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3822	008	0	1	02	01	H3822_008_0	16	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3822	801	0	1	01	01	H3822_801_0	2		1																																																																																									
H3822	802	0	1	01	01	H3822_802_0	2		1																																																																																									
H3822	803	0	1	01	01	H3822_803_0	3		1																																																																																									
H3822	804	0	1	01	01	H3822_804_0	2		1																																																																																									
H3822	805	0	1	01	01	H3822_805_0	2		1																																																																																									
H3822	806	0	1	01	01	H3822_806_0	2		1																																																																																									
H3822	807	0	1	01	01	H3822_807_0	2		1																																																																																									
H3822	808	0	1	01	01	H3822_808_0	2		1																																																																																									
H3822	809	0	1	01	01	H3822_809_0	3		2																																																																																									
H3822	810	0	1	01	01	H3822_810_0	2		2																																																																																									
H3832	001	0	1	04	01	H3832_001_0	9	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3832	006	0	1	04	01	H3832_006_0	11	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3832	801	0	1	04	01	H3832_801_0	4		1																																																																																									
H3832	802	0	1	04	01	H3832_802_0	5		1																																																																																									
H3832	805	0	1	04	01	H3832_805_0	4		2																																																																																									
H3832	806	0	1	04	01	H3832_806_0	4		2																																																																																									
H3864	002	0	1	01	01	H3864_002_0	5		2																																																																																									
H3864	006	0	1	01	01	H3864_006_0	9	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3864	014	0	1	01	01	H3864_014_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3864	015	0	1	01	01	H3864_015_0	8	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3864	016	0	1	01	01	H3864_016_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3864	019	0	1	01	01	H3864_019_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3864	020	0	1	01	01	H3864_020_0	8	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3864	021	0	1	01	01	H3864_021_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3864	801	0	1	01	01	H3864_801_0	5		2																																																																																									
H3864	803	0	1	01	01	H3864_803_0	5		1																																																																																									
H3887	001	0	1	02	01	H3887_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3887	003	0	1	02	01	H3887_003_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3907	002	0	1	01	01	H3907_002_0	8		2																																																																																									
H3907	006	0	1	01	01	H3907_006_0	8	4A7	1	3	110110	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2							3							1			2																								
H3907	029	0	1	01	01	H3907_029_0	10	4A7	1	3	110110	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2							3							1			2																								
H3907	032	0	1	01	01	H3907_032_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	2
H3907	037	0	1	01	01	H3907_037_0	9	4A7	1	3	110110	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2							3							1			2																								
H3907	038	0	1	01	01	H3907_038_0	6		2																																																																																									
H3907	039	0	1	01	01	H3907_039_0	7	4A7	1	3	110110	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2							3							1			2																								
H3907	801	0	1	01	01	H3907_801_0	7		2																																																																																									
H3907	802	0	1	01	01	H3907_802_0	6		1																																																																																									
H3907	803	0	1	01	01	H3907_803_0	6		1																																																																																									
H3908	001	0	1	20	08	H3908_001_0	1		1																																																																																									
H3908	002	0	1	20	08	H3908_002_0	1		1																																																																																									
H3909	001	0	1	04	01	H3909_001_0	8	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	285.00	2	010000	1				1	1	0110	2			2	3							1			2																								
H3909	007	0	1	04	01	H3909_007_0	7		2																																																																																									
H3909	009	0	1	04	01	H3909_009_0	9	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	285.00	2	010000	1				1	1	0110	2			2	3							1			2																								
H3909	801	0	1	04	01	H3909_801_0	4		2																																																																																									
H3909	802	0	1	04	01	H3909_802_0	4		1																																																																																									
H3912	001	0	1	04	01	H3912_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H3916	001	0	1	04	01	H3916_001_0	5	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3916	002	0	1	04	01	H3916_002_0	5	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3916	005	0	1	04	01	H3916_005_0	5	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3916	012	0	1	04	01	H3916_012_0	4		2																																																																																									
H3916	015	0	1	04	01	H3916_015_0	5	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3916	018	0	1	04	01	H3916_018_0	5	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3916	019	0	1	04	01	H3916_019_0	5	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3916	020	0	1	04	01	H3916_020_0	5	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3916	022	0	1	04	01	H3916_022_0	5	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3916	024	0	1	04	01	H3916_024_0	5	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3916	025	0	1	04	01	H3916_025_0	5	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3916	032	0	1	04	01	H3916_032_0	5	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3916	033	0	1	04	01	H3916_033_0	5	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3916	801	0	1	04	01	H3916_801_0	3		2																																																																																									
H3916	802	0	1	04	01	H3916_802_0	3		1																																																																																									
H3916	804	0	1	04	01	H3916_804_0	3		1																																																																																									
H3917	001	0	1	20	08	H3917_001_0	1		1																																																																																									
H3917	002	0	1	20	08	H3917_002_0	1		1																																																																																									
H3918	001	0	1	20	08	H3918_001_0	1		1																																																																																									
H3918	002	0	1	20	08	H3918_002_0	1		1																																																																																									
H3919	001	0	1	20	08	H3919_001_0	1		1																																																																																									
H3919	002	0	1	20	08	H3919_002_0	1		1																																																																																									
H3921	001	0	1	04	01	H3921_001_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3921	008	0	1	04	01	H3921_008_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3921	009	0	1	04	01	H3921_009_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3923	013	0	1	04	01	H3923_013_0	8	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3923	017	0	1	04	01	H3923_017_0	8	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3923	801	0	1	04	01	H3923_801_0	5		1																																																																																									
H3923	802	0	1	04	01	H3923_802_0	5		2																																																																																									
H3923	803	0	1	04	01	H3923_803_0	5		1																																																																																									
H3924	001	0	1	04	01	H3924_001_0	3		2																																																																																									
H3924	003	0	1	04	01	H3924_003_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3924	021	0	1	04	01	H3924_021_0	3		2																																																																																									
H3924	023	0	1	04	01	H3924_023_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3924	045	0	1	04	01	H3924_045_0	3		2																																																																																									
H3924	046	0	1	04	01	H3924_046_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3924	047	0	1	04	01	H3924_047_0	3		2																																																																																									
H3924	048	0	1	04	01	H3924_048_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3924	051	0	1	04	01	H3924_051_0	3		2																																																																																									
H3924	052	0	1	04	01	H3924_052_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3924	053	0	1	04	01	H3924_053_0	3		2																																																																																									
H3924	054	0	1	04	01	H3924_054_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3924	801	0	1	04	01	H3924_801_0	3		2																																																																																									
H3924	802	0	1	04	01	H3924_802_0	3		1																																																																																									
H3925	001	0	1	20	08	H3925_001_0	2		1																																																																																									
H3925	002	0	1	20	08	H3925_002_0	2		1																																																																																									
H3928	001	0	1	01	01	H3928_001_0	9	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H3928	801	0	1	01	01	H3928_801_0	6		1																																																																																									
H3928	802	0	1	01	01	H3928_802_0	6		1																																																																																									
H3928	803	0	1	01	01	H3928_803_0	6		2																																																																																									
H3931	004	0	1	01	01	H3931_004_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3931	054	0	1	01	01	H3931_054_0	4		2																																																																																									
H3931	055	0	1	01	01	H3931_055_0	4		2																																																																																									
H3931	058	0	1	01	01	H3931_058_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3931	064	0	1	01	01	H3931_064_0	6	4A7	1	3	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	275.00	1						3							3							1			2																								
H3931	065	0	1	01	01	H3931_065_0	7	4A7	1	3	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	260.00	1						3							3							1			2																								
H3931	070	0	1	01	01	H3931_070_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3931	081	0	1	01	01	H3931_081_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3931	082	0	1	01	01	H3931_082_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3931	083	0	1	01	01	H3931_083_0	6	4A7	1	3	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	275.00	1						3							3							1			2																								
H3931	084	0	1	01	01	H3931_084_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H3931	801	0	1	01	01	H3931_801_0	1		2																																																																																									
H3931	804	0	1	01	01	H3931_804_0	1		1																																																																																									
H3942	001	0	1	20	08	H3942_001_0	1		1																																																																																									
H3942	002	0	1	20	08	H3942_002_0	1		1																																																																																									
H3945	002	0	1	01	01	H3945_002_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H3945	003	0	1	02	01	H3945_003_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3945	006	0	1	01	01	H3945_006_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H3945	801	0	1	01	01	H3945_801_0	1		1																																																																																									
H3945	802	0	1	02	01	H3945_802_0	1		1																																																																																									
H3945	803	0	1	01	01	H3945_803_0	1		1																																																																																									
H3945	804	0	1	02	01	H3945_804_0	1		1																																																																																									
H3945	805	0	1	01	01	H3945_805_0	1		2																																																																																									
H3945	806	0	1	02	01	H3945_806_0	1		2																																																																																									
H3949	002	0	1	01	01	H3949_002_0	2	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3949	009	0	1	01	01	H3949_009_0	3		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H3949	013	0	1	01	01	H3949_013_0	2	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3949	016	0	1	01	01	H3949_016_0	2		1	1	110100	1	1	2		1	1	1	2																																																										111	30	60	90					01	30										1	31	2
H3949	024	0	1	01	01	H3949_024_0	2	5A6	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								2	1	0100	2			2	3							1			2																								
H3949	026	0	1	01	01	H3949_026_0	1		2																																																																																									
H3949	027	0	1	02	01	H3949_027_0	2	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	180.00	2	011000	1				2	1	0100	2			2	3							1			2																								
H3949	804	0	1	01	01	H3949_804_0	1		1																																																																																									
H3949	806	0	1	02	01	H3949_806_0	1		1																																																																																									
H3949	807	0	1	01	01	H3949_807_0	1		2																																																																																									
H3949	808	0	1	01	01	H3949_808_0	1		1																																																																																									
H3949	809	0	1	02	01	H3949_809_0	1		2																																																																																									
H3949	810	0	1	02	01	H3949_810_0	1		1																																																																																									
H3952	008	0	1	01	01	H3952_008_0	7		2																																																																																									
H3952	020	0	1	01	01	H3952_020_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	010000	1				1	1	0110	2			1	3							1		010000	2																								
H3952	044	0	1	01	01	H3952_044_0	6		2																																																																																									
H3952	045	0	1	01	01	H3952_045_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	010000	1				1	1	0110	2			1	3							1		010000	2																								
H3952	048	0	1	01	01	H3952_048_0	6		2																																																																																									
H3952	049	0	1	01	01	H3952_049_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	280.00	2	011000	1				1	1	0110	2			2	3							1			2																								
H3952	050	0	1	01	01	H3952_050_0	6		2																																																																																									
H3952	051	0	1	01	01	H3952_051_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	280.00	2	011000	1				1	1	0110	2			2	3							1			2																								
H3952	802	0	1	01	01	H3952_802_0	1		2																																																																																									
H3952	804	0	1	01	01	H3952_804_0	1		1																																																																																									
H3954	003	0	1	01	01	H3954_003_0	4		2																																																																																									
H3954	005	0	1	01	01	H3954_005_0	4		2																																																																																									
H3954	007	0	1	01	01	H3954_007_0	4		2																																																																																									
H3954	021	0	1	01	01	H3954_021_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	027	0	1	01	01	H3954_027_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	033	0	1	01	01	H3954_033_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	097	0	1	01	01	H3954_097_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	2
H3954	098	0	1	01	01	H3954_098_0	3		2																																																																																									
H3954	100	0	1	01	01	H3954_100_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	136	0	1	01	01	H3954_136_0	4		2																																																																																									
H3954	137	0	1	01	01	H3954_137_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	138	0	1	01	01	H3954_138_0	3		2																																																																																									
H3954	139	0	1	01	01	H3954_139_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	140	0	1	02	01	H3954_140_0	3		2																																																																																									
H3954	141	0	1	02	01	H3954_141_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	142	0	1	02	01	H3954_142_0	3		2																																																																																									
H3954	143	0	1	02	01	H3954_143_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	146	0	1	01	01	H3954_146_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	148	0	1	01	01	H3954_148_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	150	0	1	02	01	H3954_150_0	3		2																																																																																									
H3954	151	0	1	02	01	H3954_151_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	152	0	1	02	01	H3954_152_0	3		2																																																																																									
H3954	153	0	1	02	01	H3954_153_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	154	0	1	02	01	H3954_154_0	3		2																																																																																									
H3954	155	0	1	02	01	H3954_155_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H3954	801	0	1	01	01	H3954_801_0	3		2																																																																																									
H3954	802	0	1	01	01	H3954_802_0	3		1																																																																																									
H3954	803	0	1	01	01	H3954_803_0	3		2																																																																																									
H3954	804	0	1	01	01	H3954_804_0	3		1																																																																																									
H3957	003	0	1	01	01	H3957_003_0	11	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3957	006	0	1	01	01	H3957_006_0	11	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3957	020	0	1	01	01	H3957_020_0	11	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3957	021	0	1	01	01	H3957_021_0	11	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3957	024	0	1	01	01	H3957_024_0	9		2																																																																																									
H3957	025	0	1	01	01	H3957_025_0	10		2																																																																																									
H3957	031	0	1	01	01	H3957_031_0	11	4A	1	4	110110	1	1	2	2	1	1	2	2			4	2			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3957	032	0	1	01	01	H3957_032_0	11	4A	1	4	110110	1	1	2	2	1	1	2	2			4	2			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3957	036	0	1	01	01	H3957_036_0	11	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3957	037	0	1	01	01	H3957_037_0	11	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3957	805	0	1	01	01	H3957_805_0	8		2																																																																																									
H3957	806	0	1	01	01	H3957_806_0	8		1																																																																																									
H3957	808	0	1	01	01	H3957_808_0	8		1																																																																																									
H3959	001	0	1	01	01	H3959_001_0	16	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3959	002	0	1	01	01	H3959_002_0	9	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3959	010	0	1	01	01	H3959_010_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3959	011	0	1	01	01	H3959_011_0	9	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3959	031	0	1	01	01	H3959_031_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3959	032	0	1	01	01	H3959_032_0	14	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3959	033	0	1	01	01	H3959_033_0	8	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H3959	035	0	1	01	01	H3959_035_0	10		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	2
H3959	036	0	1	01	01	H3959_036_0	10		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	2
H3959	037	0	1	01	01	H3959_037_0	16	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H3959	803	0	1	01	01	H3959_803_0	7		2																																																																																									
H3959	804	0	1	01	01	H3959_804_0	6		1																																																																																									
H3959	806	0	1	01	01	H3959_806_0	6		1																																																																																									
H3962	001	0	1	01	01	H3962_001_0	6	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H3962	004	0	1	01	01	H3962_004_0	5	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3962	007	0	1	01	01	H3962_007_0	7	4D	1	4	101110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H3962	801	0	1	01	01	H3962_801_0	5		1																																																																																									
H3962	802	0	1	01	01	H3962_802_0	5		2																																																																																									
H3962	803	0	1	01	01	H3962_803_0	5		1																																																																																									
H3979	001	0	1	01	01	H3979_001_0	11	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3979	002	0	1	02	01	H3979_002_0	12	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H3979	801	0	1	01	01	H3979_801_0	1		1																																																																																									
H3979	802	0	1	01	01	H3979_802_0	1		1																																																																																									
H3979	803	0	1	01	01	H3979_803_0	1		1																																																																																									
H3979	804	0	1	01	01	H3979_804_0	1		1																																																																																									
H3979	805	0	1	01	01	H3979_805_0	1		2																																																																																									
H3979	806	0	1	01	01	H3979_806_0	1		2																																																																																									
H4000	001	0	1	20	08	H4000_001_0	1		1																																																																																									
H4000	002	0	1	20	08	H4000_002_0	1		1																																																																																									
H4003	001	0	1	02	01	H4003_001_0	8	4B	1	4	110110	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4003	009	0	1	01	01	H4003_009_0	8	4D6	1	4	110110	1	1	2	2	1	1	1	2			5	3				4				8																Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								2	1	0110	2			1	3							1		011000	2																								
H4003	015	0	1	01	01	H4003_015_0	6	4B	1	4	110110	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4003	017	0	1	01	01	H4003_017_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H4003	018	0	1	01	01	H4003_018_0	8		2																																																																																									
H4003	019	0	1	01	01	H4003_019_0	7	4B	1	4	110110	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4003	021	0	1	01	01	H4003_021_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H4003	024	0	1	01	01	H4003_024_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H4003	025	0	1	02	01	H4003_025_0	8	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H4003	027	0	1	02	01	H4003_027_0	8	3D	1	4	110110	1	1	2	2	1	1	1	2			3	2		4																						Preferred Generic, Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4003	803	0	1	02	01	H4003_803_0	5		1																																																																																									
H4003	806	0	1	02	01	H4003_806_0	5		1																																																																																									
H4003	807	0	1	02	01	H4003_807_0	5		1																																																																																									
H4004	015	0	1	02	01	H4004_015_0	7	4B	1	4	110110	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4004	025	0	1	01	01	H4004_025_0	8		2																																																																																									
H4004	048	0	1	01	01	H4004_048_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H4004	050	0	1	01	01	H4004_050_0	7	3D	1	4	110110	1	1	2	2	1	1	1	2			3	2		4																						Preferred Generic, Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4004	053	0	1	02	01	H4004_053_0	9	3D	1	4	110110	1	1	2	2	1	1	1	2			3	2		4																						Preferred Generic, Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4005	001	0	1	04	01	H4005_001_0	5		2																																																																																									
H4005	004	0	1	04	01	H4005_004_0	12	5A	1	4	101110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	1	2		1	3							1		011000	2																								
H4005	801	0	1	04	01	H4005_801_0	5		2																																																																																									
H4005	802	0	1	04	01	H4005_802_0	5		1																																																																																									
H4005	804	0	1	04	01	H4005_804_0	5		1																																																																																									
H4005	807	0	1	04	01	H4005_807_0	5		1																																																																																									
H4006	001	0	1	01	01	H4006_001_0	8		2																																																																																									
H4006	007	0	1	01	01	H4006_007_0	12	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H4006	008	0	1	02	01	H4006_008_0	14	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H4006	025	0	1	01	01	H4006_025_0	11		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H4006	803	0	1	01	01	H4006_803_0	5		2																																																																																									
H4006	807	0	1	01	01	H4006_807_0	6		1																																																																																									
H4006	809	0	1	01	01	H4006_809_0	4		1																																																																																									
H4006	811	0	1	01	01	H4006_811_0	6		1																																																																																									
H4006	813	0	1	01	01	H4006_813_0	4		1																																																																																									
H4006	816	0	1	01	01	H4006_816_0	6		1																																																																																									
H4007	005	0	1	01	01	H4007_005_0	6	3F	1	3	110110	1	1	1	2	1	1	1	2			3	3		6																						Preferred Generic, Preferred Brand, Non-Preferred Brand		1		2	000100	1				2							3							1			2																								
H4007	012	0	1	01	01	H4007_012_0	5	4B	1	4	110101	1	1	1	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011110	2																								
H4007	013	0	1	01	01	H4007_013_0	5	3F	1	4	110101	1	1	1	2	1	1	1	2			3	3		6																						Preferred Generic, Preferred Brand, Non-Preferred Brand		3								2	1	0110	2			1	3							1		011100	2																								
H4007	016	0	1	01	01	H4007_016_0	6	3F	1	3	110110	1	1	1	2	1	1	1	2			3	3		6																						Preferred Generic, Preferred Brand, Non-Preferred Brand		1		2	000100	1				2							3							1			2																								
H4007	801	0	1	01	01	H4007_801_0	2		1																																																																																									
H4007	802	0	1	01	01	H4007_802_0	2		2																																																																																									
H4007	803	0	1	01	01	H4007_803_0	2		1																																																																																									
H4007	805	0	1	01	01	H4007_805_0	2		1																																																																																									
H4007	806	0	1	01	01	H4007_806_0	2		2																																																																																									
H4007	807	0	1	01	01	H4007_807_0	2		1																																																																																									
H4007	808	0	1	01	01	H4007_808_0	2		1																																																																																									
H4007	809	0	1	01	01	H4007_809_0	2		2																																																																																									
H4007	810	0	1	01	01	H4007_810_0	2		1																																																																																									
H4011	001	0	1	04	01	H4011_001_0	10		2																																																																																									
H4011	003	0	1	04	01	H4011_003_0	12	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H4011	801	0	1	04	01	H4011_801_0	9		1																																																																																									
H4011	803	0	1	04	01	H4011_803_0	8		1																																																																																									
H4011	805	0	1	04	01	H4011_805_0	7		1																																																																																									
H4011	807	0	1	04	01	H4011_807_0	7		1																																																																																									
H4011	809	0	1	04	01	H4011_809_0	7		1																																																																																									
H4011	811	0	1	04	01	H4011_811_0	8		1																																																																																									
H4011	813	0	1	04	01	H4011_813_0	7		1																																																																																									
H4011	815	0	1	04	01	H4011_815_0	7		1																																																																																									
H4011	817	0	1	04	01	H4011_817_0	8		1																																																																																									
H4011	820	0	1	04	01	H4011_820_0	7		1																																																																																									
H4011	821	0	1	04	01	H4011_821_0	7		1																																																																																									
H4011	822	0	1	04	01	H4011_822_0	7		1																																																																																									
H4011	823	0	1	04	01	H4011_823_0	7		1																																																																																									
H4011	824	0	1	04	01	H4011_824_0	7		1																																																																																									
H4011	825	0	1	04	01	H4011_825_0	6		1																																																																																									
H4012	003	0	1	01	01	H4012_003_0	11		1	1	110110	2	1	1		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	1
H4012	008	0	1	01	01	H4012_008_0	12	5A	1	4	101110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H4036	004	0	1	04	01	H4036_004_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	60.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H4036	005	0	1	04	01	H4036_005_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	176.00	2	110001	1				2							3							1			2																								
H4036	007	0	1	04	01	H4036_007_0	4	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	140.00	2	110001	1				2							3							1			2																								
H4036	801	0	1	04	01	H4036_801_0	2		1																																																																																									
H4036	802	0	1	04	01	H4036_802_0	2		2																																																																																									
H4036	803	0	1	04	01	H4036_803_0	2		1																																																																																									
H4074	001	0	1	20	08	H4074_001_0	1		1																																																																																									
H4074	002	0	1	20	08	H4074_002_0	1		1																																																																																									
H4102	001	0	1	01	01	H4102_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4102	025	0	1	01	01	H4102_025_0	3		2																																																																																									
H4102	801	0	1	01	01	H4102_801_0	2		1																																																																																									
H4102	802	0	1	01	01	H4102_802_0	2		2																																																																																									
H4102	803	0	1	01	01	H4102_803_0	2		1																																																																																									
H4105	001	0	1	20	08	H4105_001_0	1		1																																																																																									
H4105	002	0	1	20	08	H4105_002_0	1		1																																																																																									
H4118	001	0	1	20	08	H4118_001_0	2		1																																																																																									
H4118	002	0	1	20	08	H4118_002_0	2		1																																																																																									
H4123	001	0	1	02	01	H4123_001_0	6	4B	1	4	110110	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H4123	002	0	1	01	01	H4123_002_0	6		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	34	1
H4123	003	0	1	02	01	H4123_003_0	5		2																																																																																									
H4123	004	0	1	02	01	H4123_004_0	8	4B	1	4	110110	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H4123	801	0	1	01	01	H4123_801_0	1		2																																																																																									
H4125	001	0	1	01	01	H4125_001_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H4141	001	0	1	01	01	H4141_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4141	003	0	1	01	01	H4141_003_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	010000	1				2							3							1			2																								
H4141	004	0	1	01	01	H4141_004_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H4141	006	0	1	01	01	H4141_006_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4141	007	0	1	01	01	H4141_007_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	010000	1				2							3							1			2																								
H4141	008	0	1	01	01	H4141_008_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4141	009	0	1	01	01	H4141_009_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4141	010	0	1	01	01	H4141_010_0	7	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	010000	1				2							3							1			2																								
H4141	011	0	1	01	01	H4141_011_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H4141	012	0	1	01	01	H4141_012_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	70.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H4141	013	0	1	01	01	H4141_013_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H4141	801	0	1	01	01	H4141_801_0	2		1																																																																																									
H4141	802	0	1	01	01	H4141_802_0	2		2																																																																																									
H4141	803	0	1	01	01	H4141_803_0	2		1																																																																																									
H4142	001	0	1	20	08	H4142_001_0	1		1																																																																																									
H4142	002	0	1	20	08	H4142_002_0	1		1																																																																																									
H4145	001	0	1	01	01	H4145_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4152	004	0	1	01	01	H4152_004_0	4		2																																																																																									
H4152	005	0	1	01	01	H4152_005_0	5	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H4152	007	0	1	02	01	H4152_007_0	5	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H4152	013	0	1	01	01	H4152_013_0	5	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H4152	016	0	1	02	01	H4152_016_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	010000	1				1	1	0110	2			2	3							1			2																								
H4152	815	0	1	02	01	H4152_815_0	2		1																																																																																									
H4152	817	0	1	01	01	H4152_817_0	2		1																																																																																									
H4199	001	0	1	01	01	H4199_001_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	10000.00	010000	3																								
H4199	002	0	1	01	01	H4199_002_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	4000.00	010000	3																								
H4199	004	0	1	01	01	H4199_004_0	4		2																																																																																									
H4199	005	0	1	01	01	H4199_005_0	5	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	4000.00	010000	3																								
H4199	006	0	1	01	01	H4199_006_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H4199	007	0	1	01	01	H4199_007_0	8	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	5000.00	010000	3																								
H4199	008	0	1	01	01	H4199_008_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	3																								
H4199	009	0	1	01	01	H4199_009_0	5		2																																																																																									
H4199	010	0	1	01	01	H4199_010_0	5	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	4000.00	010000	3																								
H4199	011	0	1	01	01	H4199_011_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H4199	012	0	1	01	01	H4199_012_0	8	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	5000.00	010000	3																								
H4199	013	0	1	01	01	H4199_013_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	3																								
H4199	014	0	1	01	01	H4199_014_0	5		2																																																																																									
H4199	015	0	1	01	01	H4199_015_0	5	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	4000.00	010000	3																								
H4199	016	0	1	01	01	H4199_016_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H4199	017	0	1	01	01	H4199_017_0	8	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	5000.00	010000	3																								
H4199	018	0	1	01	01	H4199_018_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	3																								
H4199	019	0	1	01	01	H4199_019_0	5		2																																																																																									
H4199	020	0	1	01	01	H4199_020_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	4000.00	010000	3																								
H4199	021	0	1	01	01	H4199_021_0	7	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H4203	001	0	1	20	08	H4203_001_0	1		1																																																																																									
H4203	002	0	1	20	08	H4203_002_0	1		1																																																																																									
H4209	001	0	1	04	01	H4209_001_0	11	5A	1	4	110101	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	195.00	2	011000	1				2	1	0110	2			1	3							1		011000	2																								
H4209	003	0	1	04	01	H4209_003_0	12	5A	1	4	110101	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	195.00	2	011000	1				2	1	0110	2			1	3							1		011000	2																								
H4209	007	0	1	04	01	H4209_007_0	5		2																																																																																									
H4209	008	0	1	04	01	H4209_008_0	5		2																																																																																									
H4209	009	0	1	04	01	H4209_009_0	10	5A	1	4	110101	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	195.00	2	011000	1				2	1	0110	2			1	3							1		011000	2																								
H4209	809	0	1	04	01	H4209_809_0	3		1																																																																																									
H4209	810	0	1	04	01	H4209_810_0	3		1																																																																																									
H4209	811	0	1	04	01	H4209_811_0	3		2																																																																																									
H4209	812	0	1	04	01	H4209_812_0	3		2																																																																																									
H4211	001	0	1	01	01	H4211_001_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			1	3							2	2525.00	011000	2																								
H4211	003	0	1	01	01	H4211_003_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							2	2325.00	010000	2																								
H4213	001	0	1	09	04	H4213_001_0	4		2																																																																																									
H4213	002	0	1	09	04	H4213_002_0	4		2																																																																																									
H4213	004	0	1	09	04	H4213_004_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	010000	1				1	1	0100	2			2	3							1			2																								
H4213	005	0	1	09	04	H4213_005_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	010000	1				1	1	0100	2			2	3							1			2																								
H4213	006	0	1	09	04	H4213_006_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	010000	1				1	1	0100	2			2	3							1			2																								
H4213	007	0	1	09	04	H4213_007_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4227	001	0	1	01	01	H4227_001_0	7		1	1	110110	1	1	2		1	1	1	1	1	1																																																								111	30	60	90					01	30		100			90					1	31	2
H4227	002	0	1	01	01	H4227_002_0	6		1	1	110110	1	1	2		1	1	1	1	1	1																																																								111	30	60	90					01	30		100			90					1	31	2
H4235	001	0	1	20	08	H4235_001_0	1		1																																																																																									
H4235	002	0	1	20	08	H4235_002_0	1		1																																																																																									
H4268	001	0	1	09	04	H4268_001_0	5		2																																																																																									
H4268	002	0	1	09	04	H4268_002_0	5	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H4270	001	0	1	02	01	H4270_001_0	8		2																																																																																									
H4270	003	0	1	02	01	H4270_003_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H4270	006	0	1	02	01	H4270_006_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H4270	801	0	1	02	01	H4270_801_0	3		1																																																																																									
H4279	001	0	1	01	01	H4279_001_0	8	4A7	1	2	110110	1	1	2		1	1	1	2			5	3				1	9																	2	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
H4279	002	0	1	01	01	H4279_002_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	2
H4305	001	0	1	20	08	H4305_001_0	1		1																																																																																									
H4305	002	0	1	20	08	H4305_002_0	1		1																																																																																									
H4326	001	0	1	20	08	H4326_001_0	2		1																																																																																									
H4326	002	0	1	20	08	H4326_002_0	2		1																																																																																									
H4346	001	0	1	01	01	H4346_001_0	8	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H4346	005	0	1	01	01	H4346_005_0	13	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H4346	006	0	1	01	01	H4346_006_0	8	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H4346	008	0	1	01	01	H4346_008_0	8	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111110	3																								
H4346	009	0	1	01	01	H4346_009_0	8	5A7	1	4	101110	1	1	2	2	1	1	2	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H4346	801	0	1	01	01	H4346_801_0	4		2																																																																																									
H4346	802	0	1	01	01	H4346_802_0	4		1																																																																																									
H4346	804	0	1	01	01	H4346_804_0	4		1																																																																																									
H4393	001	0	1	20	08	H4393_001_0	1		1																																																																																									
H4393	002	0	1	20	08	H4393_002_0	1		1																																																																																									
H4402	001	0	1	20	08	H4402_001_0	1		1																																																																																									
H4402	002	0	1	20	08	H4402_002_0	1		1																																																																																									
H4406	001	0	1	01	01	H4406_001_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4406	801	0	1	01	01	H4406_801_0	2		1																																																																																									
H4406	803	0	1	01	01	H4406_803_0	2		2																																																																																									
H4406	804	0	1	01	01	H4406_804_0	2		1																																																																																									
H4407	002	0	1	01	01	H4407_002_0	2	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H4407	004	0	1	01	01	H4407_004_0	3		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H4407	005	0	1	01	01	H4407_005_0	3		2																																																																																									
H4407	011	0	1	01	01	H4407_011_0	1		2																																																																																									
H4407	022	0	1	02	01	H4407_022_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H4408	001	0	1	04	01	H4408_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H4408	002	0	1	04	01	H4408_002_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4408	006	0	1	04	01	H4408_006_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H4408	007	0	1	04	01	H4408_007_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H4408	008	0	1	04	01	H4408_008_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4454	002	0	1	01	01	H4454_002_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H4454	012	0	1	01	01	H4454_012_0	3		2																																																																																									
H4454	020	0	1	01	01	H4454_020_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H4454	028	0	1	01	01	H4454_028_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H4454	030	0	1	02	01	H4454_030_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H4454	031	0	1	01	01	H4454_031_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H4454	032	0	1	02	01	H4454_032_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H4454	805	0	1	01	01	H4454_805_0	3		1																																																																																									
H4454	809	0	1	02	01	H4454_809_0	2		1																																																																																									
H4454	810	0	1	01	01	H4454_810_0	4		2																																																																																									
H4454	811	0	1	01	01	H4454_811_0	2		1																																																																																									
H4454	812	0	1	02	01	H4454_812_0	2		2																																																																																									
H4454	813	0	1	02	01	H4454_813_0	2		1																																																																																									
H4456	010	0	1	01	01	H4456_010_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4456	013	0	1	01	01	H4456_013_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4456	015	0	1	01	01	H4456_015_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4456	021	0	1	01	01	H4456_021_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4456	025	0	1	01	01	H4456_025_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H4456	801	0	1	01	01	H4456_801_0	2		1																																																																																									
H4456	805	0	1	01	01	H4456_805_0	2		2																																																																																									
H4456	810	0	1	01	01	H4456_810_0	2		1																																																																																									
H4461	001	0	1	01	01	H4461_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4461	004	0	1	01	01	H4461_004_0	3		2																																																																																									
H4461	015	0	1	01	01	H4461_015_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4461	018	0	1	01	01	H4461_018_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4461	022	0	1	01	01	H4461_022_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	195.00	2	010000	1				2							3							1			2																								
H4461	025	0	1	01	01	H4461_025_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4461	029	0	1	01	01	H4461_029_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4461	806	0	1	01	01	H4461_806_0	2		1																																																																																									
H4461	807	0	1	01	01	H4461_807_0	2		2																																																																																									
H4461	808	0	1	01	01	H4461_808_0	2		1																																																																																									
H4506	003	0	1	01	01	H4506_003_0	8	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011100	2																								
H4506	010	0	1	01	01	H4506_010_0	5		2																																																																																									
H4506	029	0	1	02	01	H4506_029_0	8	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011100	2																								
H4506	801	0	1	01	01	H4506_801_0	3		1																																																																																									
H4506	806	0	1	01	01	H4506_806_0	3		1																																																																																									
H4506	808	0	1	01	01	H4506_808_0	3		2																																																																																									
H4510	012	0	1	01	01	H4510_012_0	5	4B	1	4	110101	1	1	1	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011110	2																								
H4510	015	0	1	01	01	H4510_015_0	5	4B	1	4	110101	1	1	1	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011110	2																								
H4510	018	0	1	01	01	H4510_018_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	125.00	2	011000	1				2	1	0110	2			1	3							1		011111	2																								
H4510	021	0	1	01	01	H4510_021_0	6		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H4510	022	0	1	01	01	H4510_022_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4510	023	0	1	01	01	H4510_023_0	5		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H4510	024	0	1	01	01	H4510_024_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H4510	027	0	1	01	01	H4510_027_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4510	028	0	1	01	01	H4510_028_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4510	029	0	1	01	01	H4510_029_0	6	4B	1	4	110101	1	1	1	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011110	2																								
H4510	030	0	1	01	01	H4510_030_0	6	4B	1	4	110101	1	1	1	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011110	2																								
H4510	031	0	1	01	01	H4510_031_0	6		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H4510	032	0	1	01	01	H4510_032_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4510	801	0	1	01	01	H4510_801_0	2		1																																																																																									
H4510	802	0	1	01	01	H4510_802_0	2		2																																																																																									
H4510	803	0	1	01	01	H4510_803_0	2		1																																																																																									
H4510	805	0	1	01	01	H4510_805_0	2		2																																																																																									
H4510	806	0	1	01	01	H4510_806_0	2		2																																																																																									
H4513	001	0	1	01	01	H4513_001_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H4513	009	0	1	01	01	H4513_009_0	3		2																																																																																									
H4513	010	0	1	01	01	H4513_010_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H4513	804	0	1	01	01	H4513_804_0	3		1																																																																																									
H4513	808	0	1	02	01	H4513_808_0	2		1																																																																																									
H4513	809	0	1	01	01	H4513_809_0	2		2																																																																																									
H4513	810	0	1	01	01	H4513_810_0	2		1																																																																																									
H4513	811	0	1	02	01	H4513_811_0	2		2																																																																																									
H4513	812	0	1	02	01	H4513_812_0	2		1																																																																																									
H4514	001	0	1	01	01	H4514_001_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4514	007	0	1	01	01	H4514_007_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4514	801	0	1	01	01	H4514_801_0	2		1																																																																																									
H4514	803	0	1	01	01	H4514_803_0	2		2																																																																																									
H4514	806	0	1	01	01	H4514_806_0	2		1																																																																																									
H4517	001	0	1	20	08	H4517_001_0	1		1																																																																																									
H4517	002	0	1	20	08	H4517_002_0	1		1																																																																																									
H4518	001	0	1	20	08	H4518_001_0	1		1																																																																																									
H4518	002	0	1	20	08	H4518_002_0	1		1																																																																																									
H4520	006	0	1	04	01	H4520_006_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4520	022	0	1	04	01	H4520_022_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	260.00	2	011000	1				2							3							1			2																								
H4522	001	0	1	04	01	H4522_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4522	007	0	1	04	01	H4522_007_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4522	010	0	1	04	01	H4522_010_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4523	001	0	1	01	01	H4523_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4523	005	0	1	01	01	H4523_005_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4523	015	0	1	01	01	H4523_015_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4523	016	0	1	01	01	H4523_016_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4523	017	0	1	01	01	H4523_017_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4523	018	0	1	01	01	H4523_018_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4523	019	0	1	01	01	H4523_019_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4523	801	0	1	01	01	H4523_801_0	1		2																																																																																									
H4523	802	0	1	01	01	H4523_802_0	1		1																																																																																									
H4524	001	0	1	04	01	H4524_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4524	007	0	1	04	01	H4524_007_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4524	013	0	1	04	01	H4524_013_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4524	801	0	1	04	01	H4524_801_0	1		2																																																																																									
H4524	802	0	1	04	01	H4524_802_0	1		1																																																																																									
H4524	805	0	2	04	01	H4524_805_0	1		2																																																																																									
H4524	806	0	2	04	01	H4524_806_0	1		1																																																																																									
H4525	001	0	1	01	01	H4525_001_0	7	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H4525	002	0	1	01	01	H4525_002_0	7	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H4525	003	0	1	01	01	H4525_003_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	31	62	90					10		10	111	31	62	90					1	31	2
H4525	004	0	1	01	01	H4525_004_0	5		2																																																																																									
H4525	005	0	1	01	01	H4525_005_0	4		2																																																																																									
H4525	010	0	1	01	01	H4525_010_0	7	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H4525	011	0	1	01	01	H4525_011_0	5		2																																																																																									
H4525	802	0	1	01	01	H4525_802_0	2		1																																																																																									
H4525	803	0	1	01	01	H4525_803_0	2		2																																																																																									
H4525	804	0	1	01	01	H4525_804_0	2		1																																																																																									
H4525	805	0	1	01	01	H4525_805_0	2		2																																																																																									
H4527	001	0	1	01	01	H4527_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H4527	002	0	1	01	01	H4527_002_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H4527	003	0	1	01	01	H4527_003_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4527	004	0	1	01	01	H4527_004_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4527	005	0	1	01	01	H4527_005_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H4527	006	0	1	01	01	H4527_006_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4527	013	0	1	01	01	H4527_013_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H4527	015	0	1	01	01	H4527_015_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4527	024	0	1	01	01	H4527_024_0	2		2																																																																																									
H4528	001	0	1	01	01	H4528_001_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H4528	002	0	1	01	01	H4528_002_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H4528	014	0	1	01	01	H4528_014_0	4	5A6	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	8												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs		3								2	1	0100	2			2	3							1			2																								
H4528	016	0	1	01	01	H4528_016_0	3		2																																																																																									
H4564	001	0	1	18	06	H4564_001_0	8	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4564	002	0	1	18	06	H4564_002_0	4	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4564	003	0	1	18	06	H4564_003_0	4	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4564	004	0	1	18	06	H4564_004_0	6	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4564	005	0	1	18	06	H4564_005_0	5	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4564	006	0	1	18	06	H4564_006_0	5	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4564	010	0	1	18	06	H4564_010_0	2		2																																																																																									
H4564	011	0	1	18	06	H4564_011_0	2		2																																																																																									
H4564	012	0	1	18	06	H4564_012_0	2		2																																																																																									
H4564	013	0	1	18	06	H4564_013_0	4	5A	1	3	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H4564	014	0	1	18	06	H4564_014_0	4	5A	1	3	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H4564	015	0	1	18	06	H4564_015_0	4	5A	1	3	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H4564	016	0	1	18	06	H4564_016_0	2		2																																																																																									
H4564	017	0	1	18	06	H4564_017_0	4	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4564	018	0	1	18	06	H4564_018_0	5	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4564	019	0	1	18	06	H4564_019_0	4	5A	1	3	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H4564	020	0	1	18	06	H4564_020_0	2		2																																																																																									
H4564	021	0	1	18	06	H4564_021_0	4	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4564	022	0	1	18	06	H4564_022_0	5	5A	1	4	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4564	023	0	1	18	06	H4564_023_0	4	5A	1	3	101110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H4564	801	0		18	06	H4564_801_0	1		1																																																																																									
H4590	010	0	1	01	01	H4590_010_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H4590	012	0	1	01	01	H4590_012_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H4590	020	0	1	01	01	H4590_020_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4590	022	0	1	01	01	H4590_022_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4590	025	0	1	01	01	H4590_025_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H4590	027	0	1	01	01	H4590_027_0	2		2																																																																																									
H4590	029	0	1	01	01	H4590_029_0	2		2																																																																																									
H4590	033	0	1	01	01	H4590_033_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4590	037	0	1	01	01	H4590_037_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H4590	038	0	1	01	01	H4590_038_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4590	039	0	1	01	01	H4590_039_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4590	801	0	1	01	01	H4590_801_0	2		2																																																																																									
H4590	803	0	1	01	01	H4590_803_0	2		1																																																																																									
H4590	804	0	1	01	01	H4590_804_0	2		1																																																																																									
H4604	003	0	1	01	01	H4604_003_0	5	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H4604	005	0	1	01	01	H4604_005_0	3		2																																																																																									
H4604	801	0	1	01	01	H4604_801_0	2		1																																																																																									
H4604	803	0	1	01	01	H4604_803_0	2		1																																																																																									
H4604	805	0	1	01	01	H4604_805_0	2		2																																																																																									
H4605	001	0	1	04	01	H4605_001_0	6		2																																																																																									
H4605	002	0	1	04	01	H4605_002_0	15	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	180.00	1						1							3							1			2																								
H4605	004	0	1	04	01	H4605_004_0	10	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		010000	2																								
H4605	801	0	1	04	01	H4605_801_0	2		2																																																																																									
H4605	802	0	1	04	01	H4605_802_0	1		1																																																																																									
H4606	001	0	1	04	01	H4606_001_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H4606	006	0	1	04	01	H4606_006_0	4		2																																																																																									
H4714	001	0	1	20	08	H4714_001_0	1		1																																																																																									
H4714	002	0	1	20	08	H4714_002_0	1		1																																																																																									
H4738	002	0	1	04	01	H4738_002_0	5	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H4754	001	0	1	04	01	H4754_001_0	8	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4754	002	0	1	04	01	H4754_002_0	8	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4754	004	0	1	04	01	H4754_004_0	9	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4754	005	0	1	04	01	H4754_005_0	5		2																																																																																									
H4754	006	0	1	04	01	H4754_006_0	5		2																																																																																									
H4754	007	0	1	04	01	H4754_007_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4754	008	0	1	04	01	H4754_008_0	5		2																																																																																									
H4754	009	0	1	04	01	H4754_009_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4754	010	0	1	04	01	H4754_010_0	5		2																																																																																									
H4754	011	0	1	04	01	H4754_011_0	8	5A	1	4	110110	1	1	2	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H4754	012	0	1	04	01	H4754_012_0	5		2																																																																																									
H4754	801	0	1	04	01	H4754_801_0	5		2																																																																																									
H4754	802	0	1	04	01	H4754_802_0	5		1																																																																																									
H4837	001	0	1	01	01	H4837_001_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H4866	002	0	1	01	01	H4866_002_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	1
H4866	003	0	1	01	01	H4866_003_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	2				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							2	2550.00		2																								
H4866	005	0	1	01	01	H4866_005_0	5		1	1	110110	2	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	1
H4871	001	0	1	04	01	H4871_001_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H4875	016	1	1	04	01	H4875_016_1	9	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	016	2	1	04	01	H4875_016_2	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	016	3	1	04	01	H4875_016_3	9	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	016	4	1	04	01	H4875_016_4	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	016	5	1	04	01	H4875_016_5	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	017	1	1	04	01	H4875_017_1	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	017	2	1	04	01	H4875_017_2	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	017	3	1	04	01	H4875_017_3	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	017	4	1	04	01	H4875_017_4	9	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	017	5	1	04	01	H4875_017_5	9	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H4875	803	0	1	04	01	H4875_803_0	6		1																																																																																									
H4875	804	0	1	04	01	H4875_804_0	8		1																																																																																									
H4876	001	0	1	04	01	H4876_001_0	7	4A	1	4	110110	1	1	2	2	1	1	2	2			4	2			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	1	2	660.00	1	3							1		010000	2																								
H4876	801	0	1	04	01	H4876_801_0	2		1																																																																																									
H4876	802	0	1	04	01	H4876_802_0	2		1																																																																																									
H4909	009	0	1	04	01	H4909_009_0	9	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	125.00	2	110001	1				2							3							1			2																								
H4909	010	0	1	04	01	H4909_010_0	8	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	145.00	2	110001	1				2							3							1			2																								
H4909	804	0	1	04	01	H4909_804_0	2		1																																																																																									
H4909	805	0	1	04	01	H4909_805_0	2		2																																																																																									
H4909	806	0	1	04	01	H4909_806_0	2		1																																																																																									
H4910	005	0	1	01	01	H4910_005_0	6	4A7	1	3	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1		1						3							3							1			2																								
H4910	006	0	1	01	01	H4910_006_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H4910	801	0	1	01	01	H4910_801_0	1		2																																																																																									
H4910	802	0	1	01	01	H4910_802_0	1		1																																																																																									
H4956	001	0	1	04	01	H4956_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H4956	002	0	1	04	01	H4956_002_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H4956	003	0	1	04	01	H4956_003_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H4999	001	0	1	20	08	H4999_001_0	1		1																																																																																									
H4999	002	0	1	20	08	H4999_002_0	1		1																																																																																									
H5005	011	0	1	01	01	H5005_011_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5005	019	0	1	01	01	H5005_019_0	7	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H5005	801	0	1	01	01	H5005_801_0	2		2																																																																																									
H5005	803	0	1	01	01	H5005_803_0	2		1																																																																																									
H5005	804	0	1	01	01	H5005_804_0	2		1																																																																																									
H5007	001	0	1	20	08	H5007_001_0	1		1																																																																																									
H5007	002	0	1	20	08	H5007_002_0	1		1																																																																																									
H5008	001	0	1	01	01	H5008_001_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5008	002	0	1	01	01	H5008_002_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5009	001	0	1	04	01	H5009_001_0	7		2																																																																																									
H5009	002	0	1	04	01	H5009_002_0	12	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	235.00	1						1							3							1			2																								
H5009	801	0	1	04	01	H5009_801_0	3		2																																																																																									
H5009	802	0	1	04	01	H5009_802_0	2		1																																																																																									
H5010	001	0	1	04	01	H5010_001_0	9		2																																																																																									
H5010	002	0	1	04	01	H5010_002_0	14	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	225.00	1						1							3							1			2																								
H5010	004	0	1	04	01	H5010_004_0	13	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		010000	2																								
H5037	001	0	1	20	08	H5037_001_0	1		1																																																																																									
H5037	002	0	1	20	08	H5037_002_0	1		1																																																																																									
H5041	001	0	1	04	01	H5041_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	002	0	1	04	01	H5041_002_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	006	0	1	04	01	H5041_006_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	007	0	1	04	01	H5041_007_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	008	0	1	04	01	H5041_008_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	009	0	1	04	01	H5041_009_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	012	0	1	04	01	H5041_012_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	013	0	1	04	01	H5041_013_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	015	0	1	04	01	H5041_015_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	016	0	1	04	01	H5041_016_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5041	017	0	1	04	01	H5041_017_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H5042	001	0	1	04	01	H5042_001_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5042	004	0	1	04	01	H5042_004_0	8		2																																																																																									
H5042	005	0	1	04	01	H5042_005_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5042	007	0	1	04	01	H5042_007_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5042	801	0	1	04	01	H5042_801_0	5		1																																																																																									
H5042	802	0	1	04	01	H5042_802_0	4		1																																																																																									
H5042	803	0	1	04	01	H5042_803_0	4		2																																																																																									
H5048	001	0	1	01	01	H5048_001_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5048	002	0	1	01	01	H5048_002_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5048	801	0	1	01	01	H5048_801_0	3		1																																																																																									
H5048	802	0	1	01	01	H5048_802_0	4		1																																																																																									
H5048	803	0	1	01	01	H5048_803_0	3		2																																																																																									
H5050	001	0	1	01	01	H5050_001_0	6		2																																																																																									
H5050	004	0	1	01	01	H5050_004_0	7	4C	1	4	110110	2	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		3								1	1	0100	2			2	3							1			2																								
H5050	009	0	1	01	01	H5050_009_0	6	4C	1	3	110110	2	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		2	250.00	1						1							3							1			2																								
H5050	013	0	1	01	01	H5050_013_0	6	4C	1	3	110110	2	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		1		1						1							3							1			2																								
H5050	014	0	1	01	01	H5050_014_0	7	4C	1	3	110110	2	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		2	200.00	1						1							3							1			2																								
H5050	801	0	1	01	01	H5050_801_0	5		2																																																																																									
H5050	802	0	1	01	01	H5050_802_0	5		1																																																																																									
H5087	001	0	1	01	01	H5087_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	1	0010	1	2		1	3							1		010000	2																								
H5087	002	0	1	01	01	H5087_002_0	5	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	1	0010	1	2		1	3							1		010000	2																								
H5087	005	0	1	01	01	H5087_005_0	5	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5087	009	0	1	01	01	H5087_009_0	5	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5087	010	0	1	01	01	H5087_010_0	5	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5087	011	0	1	01	01	H5087_011_0	5	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5087	012	0	1	01	01	H5087_012_0	6	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5087	014	0	1	01	01	H5087_014_0	6	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5087	015	0	1	01	01	H5087_015_0	6	5A	1	4	110101	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5106	013	0	1	04	01	H5106_013_0	8	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5106	014	0	1	04	01	H5106_014_0	8	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5106	015	0	1	04	01	H5106_015_0	8	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5106	016	0	1	04	01	H5106_016_0	8	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5106	017	0	1	04	01	H5106_017_0	7		2																																																																																									
H5106	018	0	1	04	01	H5106_018_0	7		2																																																																																									
H5106	025	0	1	04	01	H5106_025_0	10	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	1						2	1	0110	2			2	3							1			2																								
H5106	027	0	1	04	01	H5106_027_0	7	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5106	028	0	1	04	01	H5106_028_0	7	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5106	806	0	1	04	01	H5106_806_0	5		1																																																																																									
H5106	807	0	1	04	01	H5106_807_0	5		2																																																																																									
H5106	808	0	1	04	01	H5106_808_0	6		1																																																																																									
H5124	001	0	1	20	08	H5124_001_0	2		1																																																																																									
H5124	002	0	1	20	08	H5124_002_0	2		1																																																																																									
H5141	001	0	1	04	01	H5141_001_0	8	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011000	1				2	1	0100	2			2	3							1			2																								
H5141	003	0	1	04	01	H5141_003_0	8		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H5151	002	0	1	01	01	H5151_002_0	8	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H5151	004	0	1	01	01	H5151_004_0	8		2																																																																																									
H5151	006	0	1	01	01	H5151_006_0	9	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H5151	007	0	1	01	01	H5151_007_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H5151	802	0	1	01	01	H5151_802_0	3		2																																																																																									
H5151	803	0	1	01	01	H5151_803_0	4		1																																																																																									
H5167	001	0	1	20	08	H5167_001_0	1		1																																																																																									
H5167	002	0	1	20	08	H5167_002_0	1		1																																																																																									
H5172	002	0	1	48	05	H5172_002_0	4	MM_5D	1	4	110110	1	1		2	1	1	1	2			5	2																				4				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			2	1	001000	2		3		011111			1																						
H5190	001	0	1	01	01	H5190_001_0	8	4E	1	4	110110	1	1	2	2	1	1	2	2			4	3			5																					Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H5190	002	0	1	01	01	H5190_002_0	8	4E	1	4	110110	1	1	2	2	1	1	2	2			4	3			5																					Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H5190	003	0	1	01	01	H5190_003_0	8	4E	1	4	110110	1	1	2	2	1	1	2	2			4	3			5																					Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs		1		2	010000	1				1	1	0010	2			1	3							1		010000	2																								
H5207	001	0	1	01	01	H5207_001_0	8		1	1	110100	2	1	2		1	1	1	2																																																										010	31							01	31										1	31	
H5209	002	0	1	01	01	H5209_002_0	3		1	1	110100	2	1	2		1	1	1	2																																																										110	30		90					10		10									1	31	2
H5211	001	0	1	02	01	H5211_001_0	10		2																																																																																									
H5211	002	0	1	02	01	H5211_002_0	13	5A5	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	0110	2			1	3							1		100000	2																								
H5211	003	0	1	02	01	H5211_003_0	10		2																																																																																									
H5211	004	0	1	02	01	H5211_004_0	13	5A5	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	0110	2			1	3							1		100000	2																								
H5211	005	0	1	02	01	H5211_005_0	13	5A5	1	4	110110	1	1	2	2	1	1	2	2			6	4											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	0110	2			1	3							1		100000	2																								
H5211	006	0	1	02	01	H5211_006_0	10		2																																																																																									
H5212	001	0	1	20	08	H5212_001_0	2		1																																																																																									
H5212	002	0	1	20	08	H5212_002_0	2		1																																																																																									
H5213	001	0	1	20	08	H5213_001_0	1		1																																																																																									
H5213	002	0	1	20	08	H5213_002_0	1		1																																																																																									
H5214	003	0	1	04	01	H5214_003_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5214	004	0	1	04	01	H5214_004_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5214	008	0	1	04	01	H5214_008_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5214	009	0	1	04	01	H5214_009_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5214	011	0	1	04	01	H5214_011_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5214	012	0	1	04	01	H5214_012_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5214	014	0	1	04	01	H5214_014_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5215	001	0	1	04	01	H5215_001_0	7		2																																																																																									
H5215	002	0	1	04	01	H5215_002_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	3																								
H5215	005	0	1	04	01	H5215_005_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	3																								
H5215	006	0	1	04	01	H5215_006_0	7		2																																																																																									
H5215	007	0	1	04	01	H5215_007_0	9	5A	1	3	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			3																								
H5215	008	0	1	04	01	H5215_008_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			3																								
H5215	806	0	1	04	01	H5215_806_0	3		1																																																																																									
H5215	807	0	1	04	01	H5215_807_0	3		2																																																																																									
H5215	808	0	1	04	01	H5215_808_0	3		1																																																																																									
H5216	001	0	1	04	01	H5216_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5216	003	0	1	04	01	H5216_003_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5216	006	0	1	04	01	H5216_006_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5216	009	0	1	04	01	H5216_009_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5216	010	0	1	04	01	H5216_010_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5253	004	0	1	01	01	H5253_004_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5253	007	0	1	02	01	H5253_007_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5253	011	0	1	01	01	H5253_011_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5253	021	0	1	01	01	H5253_021_0	2		2																																																																																									
H5253	024	0	1	01	01	H5253_024_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5253	030	0	1	01	01	H5253_030_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5253	801	0	1	01	01	H5253_801_0	2		1																																																																																									
H5253	802	0	1	01	01	H5253_802_0	2		2																																																																																									
H5253	805	0	1	01	01	H5253_805_0	2		1																																																																																									
H5253	807	0	1	02	01	H5253_807_0	2		1																																																																																									
H5256	001	0	1	18	06	H5256_001_0	2		2																																																																																									
H5256	002	0	1	18	06	H5256_002_0	2		2																																																																																									
H5256	004	0	1	18	06	H5256_004_0	2		2																																																																																									
H5262	001	0	1	01	01	H5262_001_0	5	5A	1	3	110100	1	1	2	1	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	40.00	2	011000	1				2							3							1			2																								
H5262	003	0	1	01	01	H5262_003_0	8	5A	1	3	110100	1	1	2	1	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011000	1				2							3							1			2																								
H5262	004	0	1	01	01	H5262_004_0	5		2																																																																																									
H5262	005	0	1	01	01	H5262_005_0	4		2																																																																																									
H5264	002	0	1	18	06	H5264_002_0	6		2																																																																																									
H5264	003	0	1	18	06	H5264_003_0	7		2																																																																																									
H5264	005	0	1	18	06	H5264_005_0	6		2																																																																																									
H5280	001	0	1	48	05	H5280_001_0	5	MM_5D	1	4	110110	1	1		2	1	1	1	2			5	2																				4				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011111			1																						
H5291	001	0	1	01	01	H5291_001_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5291	002	0	1	01	01	H5291_002_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011000	1				2	1	0110	2			1	3							1		001111	2																								
H5291	801	0	1	01	01	H5291_801_0	2		1																																																																																									
H5291	802	0	1	01	01	H5291_802_0	2		2																																																																																									
H5291	803	0	1	01	01	H5291_803_0	2		1																																																																																									
H5294	001	0	1	01	01	H5294_001_0	7	4E	1	4	110110	1	1	2	2	1	1	2	2			4	3			5																					Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H5302	003	0	1	02	01	H5302_003_0	9	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5302	809	0	1	02	01	H5302_809_0	4		2																																																																																									
H5302	810	0	1	02	01	H5302_810_0	3		1																																																																																									
H5302	811	0	1	02	01	H5302_811_0	3		1																																																																																									
H5322	001	0	1	02	01	H5322_001_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5322	002	0	1	01	01	H5322_002_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5322	003	0	1	01	01	H5322_003_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5322	004	0	1	02	01	H5322_004_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5322	009	0	1	01	01	H5322_009_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5322	011	0	1	02	01	H5322_011_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5322	016	0	1	01	01	H5322_016_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5322	017	0	1	02	01	H5322_017_0	5	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H5322	018	0	1	02	01	H5322_018_0	3		2																																																																																									
H5322	019	0	1	02	01	H5322_019_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5322	020	0	1	02	01	H5322_020_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5322	021	0	1	02	01	H5322_021_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H5322	023	0	1	02	01	H5322_023_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5322	024	0	1	01	01	H5322_024_0	5	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H5355	001	0	1	48	05	H5355_001_0	5	MM_3A	1	4	110110	2	1		2	1	1	1	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011100			2																						
H5378	016	0	1	04	01	H5378_016_0	8	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5378	184	0	1	04	01	H5378_184_0	7	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	110.00	1						1							3							1			2																								
H5378	190	0	1	04	01	H5378_190_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5378	801	0	1	04	01	H5378_801_0	2		2																																																																																									
H5378	802	0	1	04	01	H5378_802_0	2		1																																																																																									
H5378	803	0	1	04	01	H5378_803_0	2		1																																																																																									
H5403	001	0	1	20	08	H5403_001_0	1		1																																																																																									
H5403	002	0	1	20	08	H5403_002_0	1		1																																																																																									
H5405	001	0	1	20	08	H5405_001_0	1		1																																																																																									
H5405	002	0	1	20	08	H5405_002_0	1		1																																																																																									
H5406	001	0	1	20	08	H5406_001_0	3		1																																																																																									
H5406	002	0	1	20	08	H5406_002_0	3		1																																																																																									
H5410	001	0	1	01	01	H5410_001_0	6	3A	1	4	101100	1	1	2	2	1	1	1	1	1	1	3	2		1																						Generic, Brand, Specialty Tier		3								2	1	1111	1	2		1	3							2	10000.00	010000	3																								
H5410	004	0	1	01	01	H5410_004_0	2		2																																																																																									
H5410	013	0	1	01	01	H5410_013_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
H5410	018	0	1	02	01	H5410_018_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5410	807	0	1	01	01	H5410_807_0	3		1																																																																																									
H5414	009	0	1	01	01	H5414_009_0	5	4A7	1	3	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1		1						3							3							1			2																								
H5414	019	0	1	01	01	H5414_019_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5414	023	0	1	01	01	H5414_023_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5414	024	0	1	01	01	H5414_024_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5414	801	0	1	01	01	H5414_801_0	1		2																																																																																									
H5414	803	0	1	01	01	H5414_803_0	1		1																																																																																									
H5415	056	0	1	04	01	H5415_056_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5415	066	0	1	04	01	H5415_066_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5415	069	0	1	04	01	H5415_069_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5415	070	0	1	04	01	H5415_070_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5415	801	0	1	04	01	H5415_801_0	2		1																																																																																									
H5415	803	0	1	04	01	H5415_803_0	2		2																																																																																									
H5415	804	0	1	04	01	H5415_804_0	2		1																																																																																									
H5415	806	0	2	04	01	H5415_806_0	1		1																																																																																									
H5415	807	0	2	04	01	H5415_807_0	1		2																																																																																									
H5415	808	0	2	04	01	H5415_808_0	1		1																																																																																									
H5415	815	0	1	04	01	H5415_815_0	2		1																																																																																									
H5416	016	0	1	01	01	H5416_016_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5416	806	0	1	01	01	H5416_806_0	2		1																																																																																									
H5416	807	0	1	01	01	H5416_807_0	2		2																																																																																									
H5416	808	0	1	01	01	H5416_808_0	2		1																																																																																									
H5417	001	0	1	04	01	H5417_001_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5420	001	0	1	02	01	H5420_001_0	5	4B	1	4	110100	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	5000.00	010000	2																								
H5420	003	0	1	01	01	H5420_003_0	3	4B	1	4	110100	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5420	006	0	1	02	01	H5420_006_0	4	4B	1	4	110100	1	1	2	2	1	1	1	2			4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5422	002	0	1	01	01	H5422_002_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	60.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H5422	006	0	1	01	01	H5422_006_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	145.00	2	110001	1				2							3							1			2																								
H5422	803	0	1	01	01	H5422_803_0	3		2																																																																																									
H5422	804	0	1	01	01	H5422_804_0	3		1																																																																																									
H5422	805	0	1	01	01	H5422_805_0	3		1																																																																																									
H5424	001	0	1	04	01	H5424_001_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5424	003	0	1	04	01	H5424_003_0	2		2																																																																																									
H5424	005	0	1	04	01	H5424_005_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5425	001	0	1	01	01	H5425_001_0	5	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H5425	004	0	1	01	01	H5425_004_0	5	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		011000	2																								
H5425	005	0	1	01	01	H5425_005_0	5	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		010000	2																								
H5425	006	0	1	01	01	H5425_006_0	6	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		011000	2																								
H5425	007	0	1	01	01	H5425_007_0	6	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		011000	2																								
H5425	008	0	1	01	01	H5425_008_0	7	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		011000	2																								
H5425	009	0	1	01	01	H5425_009_0	7	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		011000	2																								
H5425	010	0	1	01	01	H5425_010_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	011	0	1	01	01	H5425_011_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	012	0	1	01	01	H5425_012_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	019	0	1	01	01	H5425_019_0	6	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H5425	020	0	1	01	01	H5425_020_0	6	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H5425	022	0	1	01	01	H5425_022_0	4	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H5425	028	0	1	01	01	H5425_028_0	5	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H5425	029	0	1	01	01	H5425_029_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	030	0	1	01	01	H5425_030_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	031	0	1	01	01	H5425_031_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	033	0	1	01	01	H5425_033_0	5	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H5425	034	0	1	01	01	H5425_034_0	5	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H5425	035	0	1	01	01	H5425_035_0	4	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H5425	037	0	1	01	01	H5425_037_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	040	0	1	01	01	H5425_040_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	041	0	1	01	01	H5425_041_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	045	0	1	01	01	H5425_045_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5425	046	0	1	01	01	H5425_046_0	5	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H5425	047	0	1	01	01	H5425_047_0	3	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H5425	048	0	1	01	01	H5425_048_0	3	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		111000	3																								
H5425	049	0	1	01	01	H5425_049_0	4	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H5425	050	0	1	01	01	H5425_050_0	4	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		110000	3																								
H5425	051	0	1	01	01	H5425_051_0	4	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H5425	801	0	1	01	01	H5425_801_0	4		2																																																																																									
H5425	803	0	1	01	01	H5425_803_0	4		1																																																																																									
H5425	804	0	1	01	01	H5425_804_0	4		1																																																																																									
H5427	052	0	1	01	01	H5427_052_0	2		2																																																																																									
H5427	053	0	1	01	01	H5427_053_0	5	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5427	054	0	1	01	01	H5427_054_0	4	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5427	059	0	1	01	01	H5427_059_0	6	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5427	060	0	1	01	01	H5427_060_0	4	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5427	070	0	1	01	01	H5427_070_0	4	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5427	072	0	1	01	01	H5427_072_0	4	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5427	076	0	1	01	01	H5427_076_0	4	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5427	077	0	1	01	01	H5427_077_0	4	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5427	078	0	1	01	01	H5427_078_0	4		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	1
H5427	082	0	1	01	01	H5427_082_0	6	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5427	083	0	1	01	01	H5427_083_0	5	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5427	087	0	1	01	01	H5427_087_0	4		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	1
H5427	088	0	1	01	01	H5427_088_0	3	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5428	001	0	1	01	01	H5428_001_0	9	2A	1	4	110100	1	1	2	2	1	1	1	1	1	1	2	2	1																							Generic, Brand		1		2	010000	1				1	1	0010	2			2	3							2	2430.00		2																								
H5430	001	0	1	01	01	H5430_001_0	6	5A	1	4	101100	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H5431	001	0	1	01	01	H5431_001_0	6	5A4	1	4	101100	1	1	2	2	1	1	1	1	1	1	6	4											1	7												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs		3								2	1	0100	1	2		1	3							3		111111	2	1																							
H5431	002	0	1	01	01	H5431_002_0	6	5A4	1	4	101100	1	1	2	2	1	1	1	1	1	1	6	4											1	7												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs		3								2	1	0100	1	2		1	3							3		111111	2	1																							
H5431	005	0	1	01	01	H5431_005_0	8	5A4	1	4	101100	1	1	2	2	1	1	1	1	1	1	6	4											1	7												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs		3								2	1	0100	1	2		1	3							1		111000	2	1																							
H5431	006	0	1	01	01	H5431_006_0	6	5A4	1	4	110100	1	1	2	2	1	1	1	1	1	1	6	4											1	7												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs		1		2	100000	1				2	1	0010	1	2		1	3							1		100000	2	1																							
H5431	007	0	1	01	01	H5431_007_0	6	5A4	1	4	101100	1	1	2	2	1	1	1	1	1	1	6	4											1	7												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs		3								2	1	0100	1	2		1	3							3		111111	2	1																							
H5431	008	0	1	01	01	H5431_008_0	6	5A4	1	4	101100	1	1	2	2	1	1	1	1	1	1	6	4											1	7												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs		3								2	1	0100	1	2		1	3							3		111111	2	1																							
H5431	009	0	1	01	01	H5431_009_0	7	5A4	1	4	101100	1	1	2	2	1	1	1	1	1	1	6	4											1	7												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Supplemental Brand and Generic Drugs		3								2	1	0100	1	2		1	3							1		111000	2	1																							
H5433	001	0	1	01	01	H5433_001_0	11	2A	1	4	110100	1	1	2	2	1	1	1	2			2	2	1																							Generic, Brand		3								1	1	0110	2			2	3							2	2000.00		2																								
H5434	002	0	1	04	01	H5434_002_0	10	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011001	2																								
H5434	801	0	1	04	01	H5434_801_0	3		1																																																																																									
H5434	802	0	1	04	01	H5434_802_0	2		1																																																																																									
H5435	001	0	1	09	04	H5435_001_0	2		2																																																																																									
H5435	014	0	1	09	04	H5435_014_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5435	024	0	1	09	04	H5435_024_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H5439	001	0	1	04	01	H5439_001_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5439	002	0	1	04	01	H5439_002_0	6	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5439	005	0	1	04	01	H5439_005_0	7	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5439	006	0	1	04	01	H5439_006_0	7	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5439	007	0	1	04	01	H5439_007_0	7	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5439	008	0	1	04	01	H5439_008_0	7	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5439	009	0	1	04	01	H5439_009_0	7	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5439	801	0	1	04	01	H5439_801_0	1		1																																																																																									
H5439	802	0	1	04	01	H5439_802_0	1		2																																																																																									
H5439	803	0	1	04	01	H5439_803_0	1		1																																																																																									
H5471	001	0	1	01	01	H5471_001_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		1	3							1		011000	2																								
H5471	002	0	1	01	01	H5471_002_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							3		011111	2																								
H5471	003	0	1	02	01	H5471_003_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							2	5000.00	011000	2																								
H5471	004	0	1	01	01	H5471_004_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	005	0	1	01	01	H5471_005_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	007	0	1	01	01	H5471_007_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		1	3							1		011000	2																								
H5471	008	0	1	01	01	H5471_008_0	5	5A	1	4	110100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	009	0	1	01	01	H5471_009_0	6	5A	1	4	110100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	010	0	1	01	01	H5471_010_0	3	5A	1	4	110100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	011	0	1	01	01	H5471_011_0	3	5A	1	4	110100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	012	0	1	01	01	H5471_012_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	10000.00	011110	2																								
H5471	013	0	1	01	01	H5471_013_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		1	3							1		011000	2																								
H5471	014	0	1	01	01	H5471_014_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							2	4000.00	011000	2																								
H5471	015	0	1	02	01	H5471_015_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	016	0	1	01	01	H5471_016_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5471	017	0	1	01	01	H5471_017_0	3	5A	1	4	110100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	018	0	1	01	01	H5471_018_0	3	5A	1	4	110100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	019	0	1	01	01	H5471_019_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011110	2																								
H5471	020	0	1	01	01	H5471_020_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011110	2																								
H5471	021	0	1	01	01	H5471_021_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	022	0	1	01	01	H5471_022_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5471	024	0	1	01	01	H5471_024_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5471	025	0	1	01	01	H5471_025_0	5	4A	1	4	110100	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	1	2		2	3							1			2																								
H5471	027	0	1	01	01	H5471_027_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		1	3							1		011000	2																								
H5471	028	0	1	01	01	H5471_028_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	029	0	1	01	01	H5471_029_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5471	030	0	1	01	01	H5471_030_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011110	2																								
H5471	031	0	1	01	01	H5471_031_0	6		1	1	110100	1	1	2		1	1	1	2																																																										110	30		90					01	30										1	31	2
H5471	032	0	1	01	01	H5471_032_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		1	3							1		011000	2																								
H5471	033	0	1	02	01	H5471_033_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5471	034	0	1	02	01	H5471_034_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011110	2																								
H5471	039	0	1	01	01	H5471_039_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	1	2		1	3							1		011000	2																								
H5471	042	0	1	01	01	H5471_042_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011110	2																								
H5471	043	0	1	01	01	H5471_043_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5471	044	0	1	01	01	H5471_044_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5471	045	0	1	01	01	H5471_045_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5471	046	0	1	01	01	H5471_046_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5475	001	0	1	01	01	H5475_001_0	11		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	2
H5475	002	0	1	01	01	H5475_002_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			2	3							1			2																								
H5493	001	0	1	20	08	H5493_001_0	1		1																																																																																									
H5493	002	0	1	20	08	H5493_002_0	1		1																																																																																									
H5507	001	0	1	04	01	H5507_001_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5508	001	0	1	04	01	H5508_001_0	10	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5508	002	0	1	04	01	H5508_002_0	12		2																																																																																									
H5508	005	0	1	04	01	H5508_005_0	14	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5508	006	0	1	04	01	H5508_006_0	13	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5508	801	0	1	04	01	H5508_801_0	10		1																																																																																									
H5508	802	0	1	04	01	H5508_802_0	9		2																																																																																									
H5508	803	0	1	04	01	H5508_803_0	8		2																																																																																									
H5508	804	0	1	04	01	H5508_804_0	9		1																																																																																									
H5509	001	0	1	04	01	H5509_001_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5509	003	0	1	04	01	H5509_003_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5509	010	0	1	04	01	H5509_010_0	5	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5509	011	0	1	04	01	H5509_011_0	5	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5509	012	0	1	04	01	H5509_012_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5509	016	0	1	04	01	H5509_016_0	4	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5509	017	0	1	04	01	H5509_017_0	5	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5509	018	0	1	04	01	H5509_018_0	4	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5509	019	0	1	04	01	H5509_019_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5509	801	0	1	04	01	H5509_801_0	1		1																																																																																									
H5509	802	0	1	04	01	H5509_802_0	1		2																																																																																									
H5509	803	0	1	04	01	H5509_803_0	1		1																																																																																									
H5516	001	0	1	04	01	H5516_001_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5520	001	0	1	04	01	H5520_001_0	3		2																																																																																									
H5520	002	0	1	04	01	H5520_002_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5520	003	0	1	04	01	H5520_003_0	3		2																																																																																									
H5520	004	0	1	04	01	H5520_004_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5520	006	0	1	04	01	H5520_006_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5520	009	0	1	04	01	H5520_009_0	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5520	012	1	1	04	01	H5520_012_1	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5520	012	2	1	04	01	H5520_012_2	5	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5520	012	3	1	04	01	H5520_012_3	6	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H5520	807	0	1	04	01	H5520_807_0	1		2																																																																																									
H5520	808	0	1	04	01	H5520_808_0	1		1																																																																																									
H5520	809	0	1	04	01	H5520_809_0	1		1																																																																																									
H5521	012	0	1	04	01	H5521_012_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	013	0	1	04	01	H5521_013_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	015	0	1	04	01	H5521_015_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	016	0	1	04	01	H5521_016_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	020	0	1	04	01	H5521_020_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	022	0	1	04	01	H5521_022_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	027	0	1	04	01	H5521_027_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	028	0	1	04	01	H5521_028_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	033	0	1	04	01	H5521_033_0	5	4A7	1	3	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		1		1						3							3							1			2																								
H5521	037	0	1	04	01	H5521_037_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	038	0	1	04	01	H5521_038_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	040	0	1	04	01	H5521_040_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5521	801	0	1	04	01	H5521_801_0	1		2																																																																																									
H5521	802	0	1	04	01	H5521_802_0	1		1																																																																																									
H5521	805	0	2	04	01	H5521_805_0	1		2																																																																																									
H5521	806	0	2	04	01	H5521_806_0	1		1																																																																																									
H5522	001	0	1	04	01	H5522_001_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5522	002	0	1	04	01	H5522_002_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5522	004	0	1	04	01	H5522_004_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5522	005	0	1	04	01	H5522_005_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5522	008	0	1	04	01	H5522_008_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5522	009	0	1	04	01	H5522_009_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5522	013	0	1	04	01	H5522_013_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5522	014	0	1	04	01	H5522_014_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5522	015	0	1	04	01	H5522_015_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5522	802	0	1	04	01	H5522_802_0	4		2																																																																																									
H5522	803	0	1	04	01	H5522_803_0	4		1																																																																																									
H5522	805	0	1	04	01	H5522_805_0	4		1																																																																																									
H5525	004	0	1	04	01	H5525_004_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5525	005	0	1	04	01	H5525_005_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5525	006	0	1	04	01	H5525_006_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5525	007	0	1	04	01	H5525_007_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5526	004	0	1	04	01	H5526_004_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H5526	014	0	1	04	01	H5526_014_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
H5526	806	0	1	04	01	H5526_806_0	1		2																																																																																									
H5526	808	0	1	04	01	H5526_808_0	1		1																																																																																									
H5526	810	0	1	04	01	H5526_810_0	5		1																																																																																									
H5528	001	0	1	04	01	H5528_001_0	6		2																																																																																									
H5528	002	0	1	04	01	H5528_002_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5528	003	0	1	04	01	H5528_003_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5528	004	0	1	04	01	H5528_004_0	6		2																																																																																									
H5528	005	0	1	04	01	H5528_005_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5528	008	0	1	04	01	H5528_008_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5528	009	0	1	04	01	H5528_009_0	6		2																																																																																									
H5528	010	0	1	04	01	H5528_010_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5528	011	0	1	04	01	H5528_011_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5528	018	0	1	04	01	H5528_018_0	6	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H5528	804	0	1	04	01	H5528_804_0	2		2																																																																																									
H5528	807	0	1	04	01	H5528_807_0	2		1																																																																																									
H5528	814	0	1	04	01	H5528_814_0	3		1																																																																																									
H5529	001	0	1	04	01	H5529_001_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	150.00	2	110001	1				2							3							1			2																								
H5529	004	0	1	04	01	H5529_004_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	70.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H5529	804	0	1	04	01	H5529_804_0	2		1																																																																																									
H5529	805	0	1	04	01	H5529_805_0	2		2																																																																																									
H5529	806	0	1	04	01	H5529_806_0	2		1																																																																																									
H5530	001	0	1	04	01	H5530_001_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	135.00	2	110001	1				2							3							1			2																								
H5530	804	0	1	04	01	H5530_804_0	2		1																																																																																									
H5530	805	0	1	04	01	H5530_805_0	2		2																																																																																									
H5530	806	0	1	04	01	H5530_806_0	2		1																																																																																									
H5532	001	0	1	04	01	H5532_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5533	003	0	1	04	01	H5533_003_0	13	4A7	1	3	110110	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2							3							1			2																								
H5533	005	0	1	04	01	H5533_005_0	7	4A7	1	3	110110	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2							3							1			2																								
H5533	006	0	1	04	01	H5533_006_0	9	4A7	1	3	110110	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2							3							1			2																								
H5533	801	0	1	04	01	H5533_801_0	6		2																																																																																									
H5533	802	0	1	04	01	H5533_802_0	6		1																																																																																									
H5533	803	0	1	04	01	H5533_803_0	6		1																																																																																									
H5549	002	0	1	01	01	H5549_002_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5549	003	0	1	01	01	H5549_003_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5549	004	0	1	01	01	H5549_004_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5549	006	0	1	01	01	H5549_006_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5549	008	0	1	01	01	H5549_008_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5576	006	0	1	02	01	H5576_006_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H5576	007	0	1	02	01	H5576_007_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	300.00	2	011100	1				2	1	0110	2			2	3							1			2																								
H5576	008	0	1	01	01	H5576_008_0	7		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	1
H5576	009	0	1	02	01	H5576_009_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5576	012	0	1	02	01	H5576_012_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011100	1				2	1	0110	2			1	3							1		011000	2																								
H5576	801	0	1	02	01	H5576_801_0	4		1																																																																																									
H5576	802	0	1	02	01	H5576_802_0	4		1																																																																																									
H5576	803	0	1	02	01	H5576_803_0	4		2																																																																																									
H5577	002	0	1	01	01	H5577_002_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H5577	005	0	1	01	01	H5577_005_0	12	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5577	008	0	1	02	01	H5577_008_0	12	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5577	009	0	1	01	01	H5577_009_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H5577	010	0	1	01	01	H5577_010_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H5577	801	0	1	01	01	H5577_801_0	4		2																																																																																									
H5577	802	0	1	01	01	H5577_802_0	4		1																																																																																									
H5577	803	0	1	01	01	H5577_803_0	4		1																																																																																									
H5577	804	0	1	01	01	H5577_804_0	4		1																																																																																									
H5577	805	0	1	01	01	H5577_805_0	4		1																																																																																									
H5577	806	0	1	01	01	H5577_806_0	4		1																																																																																									
H5580	001	0	1	01	01	H5580_001_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	1
H5580	004	0	1	01	01	H5580_004_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	1
H5580	005	0	1	01	01	H5580_005_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	1
H5587	002	0	1	01	01	H5587_002_0	5		1	1	110110	2	1	2		1	1	1	2																																																										110	31		93					01	31		111	31	62	93					1	31	2
H5590	002	0	1	01	01	H5590_002_0	7		1	1	110110	1	1	2		1	1	2	2																																																										110	30		90					01	30		100			90					1	31	2
H5591	001	0	1	02	01	H5591_001_0	10	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5591	003	0	1	01	01	H5591_003_0	7		2																																																																																									
H5591	004	0	1	02	01	H5591_004_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5591	005	0	1	02	01	H5591_005_0	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5591	801	0	1	02	01	H5591_801_0	4		1																																																																																									
H5591	802	0	1	02	01	H5591_802_0	4		1																																																																																									
H5594	001	0	1	02	01	H5594_001_0	7	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5594	002	0	1	02	01	H5594_002_0	6	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5594	016	0	1	01	01	H5594_016_0	6		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	1
H5594	017	0	1	01	01	H5594_017_0	7		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	1
H5594	018	0	1	02	01	H5594_018_0	7	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5594	019	0	1	02	01	H5594_019_0	5	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5594	022	0	1	02	01	H5594_022_0	5	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5594	026	0	1	02	01	H5594_026_0	7	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5594	027	0	1	02	01	H5594_027_0	5	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5594	028	0	1	02	01	H5594_028_0	6	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5594	029	0	1	02	01	H5594_029_0	7	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5594	030	0	1	02	01	H5594_030_0	7	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5594	031	0	1	02	01	H5594_031_0	8	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5594	032	0	1	02	01	H5594_032_0	4	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5594	033	0	1	02	01	H5594_033_0	4	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5608	001	0	1	01	01	H5608_001_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					10		10	100			90					1	31	1
H5608	002	0	1	01	01	H5608_002_0	6	4C	1	2	110110	1	1	2		1	1	1	2			4	4			3																			3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
H5609	001	0	1	01	01	H5609_001_0	4	5A	1	4	110110	1	1	2	1	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5609	004	0	1	01	01	H5609_004_0	5	5A	1	4	110110	1	1	2	1	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5609	005	0	1	01	01	H5609_005_0	5	5A	1	4	110110	1	1	2	1	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5609	801	0	1	01	01	H5609_801_0	2		1																																																																																									
H5610	001	0	1	20	08	H5610_001_0	1		1																																																																																									
H5610	003	0	1	20	08	H5610_003_0	1		1																																																																																									
H5619	001	0	1	01	01	H5619_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5619	003	0	1	01	01	H5619_003_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	010000	1				2							3							1			2																								
H5619	007	0	1	01	01	H5619_007_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5619	009	0	1	01	01	H5619_009_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	010000	1				2							3							1			2																								
H5619	802	0	1	01	01	H5619_802_0	2		1																																																																																									
H5619	803	0	1	01	01	H5619_803_0	2		2																																																																																									
H5619	804	0	1	01	01	H5619_804_0	2		1																																																																																									
H5628	001	0	1	01	01	H5628_001_0	10	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H5628	006	0	1	01	01	H5628_006_0	9		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5629	001	0	1	20	08	H5629_001_0	1		1																																																																																									
H5629	002	0	1	20	08	H5629_002_0	1		1																																																																																									
H5640	001	0	1	01	01	H5640_001_0	3		1	1	110110	2	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H5649	001	0	1	01	01	H5649_001_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	2		1	1	150.00	1	3							1		011000	2																								
H5649	002	0	1	01	01	H5649_002_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	2		1	1	300.00	1	3							1		010000	2																								
H5649	004	0	1	01	01	H5649_004_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	2		1	1	300.00	1	3							1		010000	2																								
H5652	001	0	1	02	01	H5652_001_0	5	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H5652	002	0	1	02	01	H5652_002_0	3		2																																																																																									
H5652	003	0	1	02	01	H5652_003_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5652	004	0	1	02	01	H5652_004_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5652	006	0	1	02	01	H5652_006_0	4	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H5656	001	0	1	01	01	H5656_001_0	8	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011100	2																								
H5656	003	0	1	01	01	H5656_003_0	6		2																																																																																									
H5656	017	0	1	02	01	H5656_017_0	9	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5656	801	0	1	01	01	H5656_801_0	3		1																																																																																									
H5656	802	0	1	01	01	H5656_802_0	3		1																																																																																									
H5656	803	0	1	01	01	H5656_803_0	3		2																																																																																									
H5685	001	0	1	01	01	H5685_001_0	6	2A	1	4	110100	2	1	2	2	1	1	2	2			2	2	1																							Generic, Brand		3								3	1	0110	2			2	3							2	1910.00		2																								
H5696	002	0	1	01	01	H5696_002_0	3	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5696	004	0	1	01	01	H5696_004_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5696	021	0	1	01	01	H5696_021_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5696	024	0	1	01	01	H5696_024_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5696	028	0	1	01	01	H5696_028_0	5	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5696	030	0	1	01	01	H5696_030_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5696	033	0	1	01	01	H5696_033_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5696	034	0	1	01	01	H5696_034_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5696	035	0	1	01	01	H5696_035_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5696	037	0	1	01	01	H5696_037_0	5	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5696	038	0	1	01	01	H5696_038_0	5	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5696	039	0	1	01	01	H5696_039_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5696	040	0	1	01	01	H5696_040_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5696	041	0	1	01	01	H5696_041_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5696	043	0	1	01	01	H5696_043_0	4	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5696	046	0	1	01	01	H5696_046_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5698	028	0	1	01	01	H5698_028_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5698	035	0	1	01	01	H5698_035_0	5		2																																																																																									
H5698	062	0	1	01	01	H5698_062_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5698	063	0	1	01	01	H5698_063_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5698	128	0	1	01	01	H5698_128_0	6		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H5698	134	0	1	01	01	H5698_134_0	6		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H5698	140	0	1	01	01	H5698_140_0	6		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H5698	158	0	1	01	01	H5698_158_0	7		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H5698	159	0	1	01	01	H5698_159_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5703	001	0	1	01	01	H5703_001_0	5		1	1	110100	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30										1	31	1
H5732	001	0	1	01	01	H5732_001_0	15	5A	1	4	101110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	1	2		1	3							1		011000	2																								
H5732	801	0	1	01	01	H5732_801_0	8		1																																																																																									
H5746	006	0	1	01	01	H5746_006_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			1	3							2	2450.00	011000	2																								
H5746	012	0	1	01	01	H5746_012_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							2	2350.00	010000	2																								
H5749	001	0	1	02	01	H5749_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H5750	004	0	1	01	01	H5750_004_0	4		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H5765	001	0	1	01	01	H5765_001_0	7	5A	1	4	110110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5774	003	0	1	01	01	H5774_003_0	11		2																																																																																									
H5774	005	0	1	01	01	H5774_005_0	13	5A	1	4	101110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5774	008	0	1	01	01	H5774_008_0	16	5A	1	4	101110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5774	009	0	1	01	01	H5774_009_0	16	5A	1	4	101110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5774	014	0	1	02	01	H5774_014_0	17	5A	1	4	101110	1	1	1	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	1	1	4.00	1	3							1		011000	2																								
H5774	019	0	1	01	01	H5774_019_0	11		1	1	110110	1	1	1		1	1	1	1	1	1																																																								110	30		90					01	30		100			90					1	31	1
H5774	802	0	1	01	01	H5774_802_0	5		2																																																																																									
H5774	806	0	1	01	01	H5774_806_0	10		1																																																																																									
H5774	808	0	1	01	01	H5774_808_0	5		1																																																																																									
H5779	001	0	1	01	01	H5779_001_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	2
H5779	002	0	1	01	01	H5779_002_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			2	3							1			2																								
H5782	001	0	1	01	01	H5782_001_0	7	2A	1	4	110110	1	1	2	2	1	1	1	1	1	1	2	2	1																							Generic, Brand		3								3	1	0110	2			2	3							2	2200.00		2																								
H5786	001	0	1	01	01	H5786_001_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	2
H5786	002	0	1	01	01	H5786_002_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			2	3							1			2																								
H5793	001	0	1	01	01	H5793_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5793	008	0	1	01	01	H5793_008_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5793	801	0	1	01	01	H5793_801_0	1		2																																																																																									
H5793	802	0	1	01	01	H5793_802_0	1		1																																																																																									
H5810	001	0	1	01	01	H5810_001_0	10	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H5810	007	0	1	01	01	H5810_007_0	8		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5811	001	0	1	01	01	H5811_001_0	5	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		011000	2																								
H5811	002	0	1	01	01	H5811_002_0	4		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5811	005	0	1	01	01	H5811_005_0	4	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H5813	003	0	1	01	01	H5813_003_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5813	006	0	1	01	01	H5813_006_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5813	801	0	1	01	01	H5813_801_0	1		2																																																																																									
H5813	802	0	1	01	01	H5813_802_0	1		1																																																																																									
H5817	009	0	1	01	01	H5817_009_0	13	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				1	1	0010	2			1	3							2	2500.00	011000	2																								
H5817	010	0	1	01	01	H5817_010_0	13	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							2	2300.00		2																								
H5822	001	0	1	20	08	H5822_001_0	1		1																																																																																									
H5822	002	0	1	20	08	H5822_002_0	1		1																																																																																									
H5823	006	0	1	01	01	H5823_006_0	8		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5826	005	0	1	01	01	H5826_005_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	34		90					01	34		100			90					1	34	1
H5826	006	0	1	01	01	H5826_006_0	6		2																																																																																									
H5826	008	0	1	01	01	H5826_008_0	7	3D	1	4	110110	1	1	2	2	1	1	1	2			3	3		4																						Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5826	009	0	1	01	01	H5826_009_0	7	3D	1	4	110110	1	1	2	2	1	1	1	2			3	3		4																						Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5826	010	0	1	01	01	H5826_010_0	7	3D	1	4	110110	1	1	2	2	1	1	1	2			3	3		4																						Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5832	001	0	1	01	01	H5832_001_0	7	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5832	801	0	1	01	01	H5832_801_0	1		2																																																																																									
H5832	802	0	1	01	01	H5832_802_0	1		1																																																																																									
H5850	002	0	1	01	01	H5850_002_0	14	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5850	003	0	1	01	01	H5850_003_0	8	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5850	004	0	1	01	01	H5850_004_0	8	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5850	006	0	1	01	01	H5850_006_0	8	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5850	007	0	1	01	01	H5850_007_0	8	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5850	012	0	1	01	01	H5850_012_0	9	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0111	1	2		1	3							2	6000.00	010000	2																								
H5850	022	0	1	01	01	H5850_022_0	8	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5850	023	0	1	01	01	H5850_023_0	7	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5850	025	0	1	01	01	H5850_025_0	7	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H5850	027	0	1	01	01	H5850_027_0	7	4B	1	4	101110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H5850	802	0	1	01	01	H5850_802_0	3		1																																																																																									
H5850	803	0	1	01	01	H5850_803_0	3		2																																																																																									
H5850	805	0	1	01	01	H5850_805_0	3		1																																																																																									
H5852	001	0	1	01	01	H5852_001_0	4	3F	1	2	110100	1	1	2		1	1	1	2			3	3		6																				1	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
H5854	005	0	1	01	01	H5854_005_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	160.00	2	110001	1				2							3							1			2																								
H5854	801	0	1	01	01	H5854_801_0	3		1																																																																																									
H5854	803	0	1	01	01	H5854_803_0	3		2																																																																																									
H5854	805	0	1	01	01	H5854_805_0	3		1																																																																																									
H5859	001	0	1	02	01	H5859_001_0	12	3F	1	4	110110	1	1	2	2	1	1	1	1	1	1	3	3		6																						Preferred Generic, Preferred Brand, Non-Preferred Brand		1		2	010000	1				1	1	0010	2			1	3							1		010000	2																								
H5859	003	0	1	02	01	H5859_003_0	11	3F	1	4	110110	1	1	2	2	1	1	1	1	1	1	3	3		6																						Preferred Generic, Preferred Brand, Non-Preferred Brand		1		2	011000	1				1	1	0010	2			2	3							1			2																								
H5868	001	0	1	04	01	H5868_001_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H5868	004	0	1	04	01	H5868_004_0	5		2																																																																																									
H5868	009	0	1	04	01	H5868_009_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H5868	010	0	1	04	01	H5868_010_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5868	011	0	1	04	01	H5868_011_0	3		2																																																																																									
H5868	012	0	1	04	01	H5868_012_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011000	1				2	1	0110	2			1	3							1		001111	2																								
H5868	013	0	1	04	01	H5868_013_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	170.00	1						2							3							1			2																								
H5883	001	1	1	02	01	H5883_001_1	7		2																																																																																									
H5883	001	2	1	02	01	H5883_001_2	7		2																																																																																									
H5883	001	3	1	02	01	H5883_001_3	7		2																																																																																									
H5883	001	4	1	02	01	H5883_001_4	7		2																																																																																									
H5883	001	5	1	02	01	H5883_001_5	7		2																																																																																									
H5883	002	1	1	02	01	H5883_002_1	8	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	002	2	1	02	01	H5883_002_2	8	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	002	3	1	02	01	H5883_002_3	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	002	4	1	02	01	H5883_002_4	8	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	002	7	1	02	01	H5883_002_7	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	003	1	1	02	01	H5883_003_1	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	003	2	1	02	01	H5883_003_2	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	003	3	1	02	01	H5883_003_3	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	003	4	1	02	01	H5883_003_4	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	003	5	1	02	01	H5883_003_5	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	004	1	1	02	01	H5883_004_1	7		1	1	110110	1	1	2		1	1	1	2																																																										110	34		90					01	34		110	34		90					1	34	2
H5883	004	2	1	02	01	H5883_004_2	7		1	1	110110	1	1	2		1	1	1	2																																																										110	34		90					01	34		110	34		90					1	34	2
H5883	004	3	1	02	01	H5883_004_3	7		1	1	110110	1	1	2		1	1	1	2																																																										110	34		90					01	34		110	34		90					1	34	2
H5883	004	4	1	02	01	H5883_004_4	7		1	1	110110	1	1	2		1	1	1	2																																																										110	34		90					01	34		110	34		90					1	34	2
H5883	004	5	1	02	01	H5883_004_5	7		1	1	110110	1	1	2		1	1	1	2																																																										110	34		90					01	34		110	34		90					1	34	2
H5883	005	0	1	01	01	H5883_005_0	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	50.00	1						2	1	0110	2			2	3							1			2																								
H5883	006	0	1	01	01	H5883_006_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H5883	801	0	1	02	01	H5883_801_0	5		2																																																																																									
H5883	805	0	1	02	01	H5883_805_0	5		1																																																																																									
H5883	807	0	1	02	01	H5883_807_0	5		1																																																																																									
H5887	001	0	1	01	01	H5887_001_0	12	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H5887	007	0	1	01	01	H5887_007_0	12	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H5887	010	0	1	01	01	H5887_010_0	12		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
H5887	012	0	1	01	01	H5887_012_0	12	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H5887	013	0	1	01	01	H5887_013_0	14	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H5887	806	0	1	01	01	H5887_806_0	6		1																																																																																									
H5887	808	0	1	01	01	H5887_808_0	6		1																																																																																									
H5887	809	0	1	01	01	H5887_809_0	6		1																																																																																									
H5887	811	0	1	01	01	H5887_811_0	6		1																																																																																									
H5887	812	0	1	01	01	H5887_812_0	6		1																																																																																									
H5887	814	0	1	01	01	H5887_814_0	6		1																																																																																									
H5887	815	0	1	01	01	H5887_815_0	6		1																																																																																									
H5887	817	0	1	01	01	H5887_817_0	6		1																																																																																									
H5887	818	0	1	01	01	H5887_818_0	6		1																																																																																									
H5887	821	0	1	01	01	H5887_821_0	7		1																																																																																									
H5887	822	0	1	01	01	H5887_822_0	7		1																																																																																									
H5887	823	0	1	01	01	H5887_823_0	7		1																																																																																									
H5887	824	0	1	01	01	H5887_824_0	7		1																																																																																									
H5887	825	0	1	01	01	H5887_825_0	7		1																																																																																									
H5887	826	0	1	01	01	H5887_826_0	6		1																																																																																									
H5896	007	0	1	01	01	H5896_007_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			1	3							2	2800.00	010000	2																								
H5902	001	0	1	20	08	H5902_001_0	2		1																																																																																									
H5902	002	0	1	20	08	H5902_002_0	2		1																																																																																									
H5926	001	0	1	01	01	H5926_001_0	9	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H5928	001	0	1	01	01	H5928_001_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	1	0010	2			1	3							1		010000	2																								
H5928	004	0	1	01	01	H5928_004_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5928	005	0	1	01	01	H5928_005_0	8	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	1	0010	2			1	3							1		010000	2																								
H5928	009	0	1	01	01	H5928_009_0	5		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		100			90					1	31	2
H5928	010	0	1	01	01	H5928_010_0	6	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5928	012	0	1	01	01	H5928_012_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5928	016	0	1	01	01	H5928_016_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5928	020	0	1	01	01	H5928_020_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5928	022	0	1	01	01	H5928_022_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5928	024	0	1	01	01	H5928_024_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5928	025	0	1	01	01	H5928_025_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	1	0010	2			1	3							1		010000	2																								
H5928	036	0	1	01	01	H5928_036_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		011000	2																								
H5928	037	0	1	01	01	H5928_037_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	1	0010	2			1	3							1		010000	2																								
H5928	038	0	1	01	01	H5928_038_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5928	040	0	1	01	01	H5928_040_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H5932	001	0	1	01	01	H5932_001_0	6		1	1	110100	2	1	2		1	1	1	2																																																										111	30	60	90					01	30										1	31	1
H5932	007	0	1	01	01	H5932_007_0	4	5A7	1	4	110110	2	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	0.00	1						1	1	0110	2			2	3							1			2																								
H5932	008	0	1	01	01	H5932_008_0	4	5A7	1	4	110110	2	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	0.00	1						1	1	0110	2			2	3							1			2																								
H5932	009	0	1	01	01	H5932_009_0	4		1	1	110100	2	1	2		1	1	1	2																																																										111	30	60	90					01	30										1	31	1
H5934	001	0	1	20	08	H5934_001_0	1		1																																																																																									
H5934	002	0	1	20	08	H5934_002_0	1		1																																																																																									
H5938	001	0	1	01	01	H5938_001_0	11	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5938	006	0	1	01	01	H5938_006_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H5938	802	0	1	01	01	H5938_802_0	6		1																																																																																									
H5938	803	0	1	01	01	H5938_803_0	5		2																																																																																									
H5938	804	0	1	01	01	H5938_804_0	5		1																																																																																									
H5943	001	0	1	02	01	H5943_001_0	7		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5943	002	0	1	01	01	H5943_002_0	7		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H5950	001	0	1	01	01	H5950_001_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H5950	801	0	1	01	01	H5950_801_0	1		2																																																																																									
H5950	802	0	1	01	01	H5950_802_0	1		1																																																																																									
H5969	001	0	1	01	01	H5969_001_0	13	5A	1	4	110110	2	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H5969	002	0	1	01	01	H5969_002_0	13		1	1	110110	2	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		110	30		90					1	31	1
H5969	801	0	1	01	01	H5969_801_0	5		1																																																																																									
H5970	001	0	1	04	01	H5970_001_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5970	002	0	1	04	01	H5970_002_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5970	004	0	1	04	01	H5970_004_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H5970	006	0	1	04	01	H5970_006_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5970	008	0	1	04	01	H5970_008_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5970	010	0	1	04	01	H5970_010_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H5970	012	0	1	04	01	H5970_012_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H5970	801	0	1	04	01	H5970_801_0	2		1																																																																																									
H5970	802	0	1	04	01	H5970_802_0	2		2																																																																																									
H5970	803	0	1	04	01	H5970_803_0	2		1																																																																																									
H5970	805	0	2	04	01	H5970_805_0	1		1																																																																																									
H5970	806	0	2	04	01	H5970_806_0	1		2																																																																																									
H5970	807	0	2	04	01	H5970_807_0	1		1																																																																																									
H5970	814	0	1	04	01	H5970_814_0	2		1																																																																																									
H5978	001	0	1	20	08	H5978_001_0	1		1																																																																																									
H5978	002	0	1	20	08	H5978_002_0	1		1																																																																																									
H5985	001	0	1	01	01	H5985_001_0	10	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5985	002	0	1	01	01	H5985_002_0	11		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	1
H5985	005	0	1	01	01	H5985_005_0	8	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H5989	002	0	1	01	01	H5989_002_0	6	4D	1	3	110110	1	1	2	2	1	1	1	2			4	1			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		1		2	011000	1				1							3							1			2																								
H5989	008	0	1	01	01	H5989_008_0	5	4D	1	3	110110	1	1	2	2	1	1	1	2			4	1			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		1		2	011000	1				1							3							1			2																								
H5991	001	0	1	01	01	H5991_001_0	8	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H5991	002	0	1	01	01	H5991_002_0	6	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
H5992	006	0	1	01	01	H5992_006_0	10	3D	1	4	110110	1	1	2	2	1	1	1	2			3	3		4																						Preferred Generic, Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	1	2		1	3							2	2480.00	010000	2																								
H5992	007	0	1	01	01	H5992_007_0	8	3D	1	4	110110	1	1	2	2	1	1	1	2			3	3		4																						Preferred Generic, Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	1	2		1	3							2	2520.00	010000	2																								
H5995	001	0	1	01	01	H5995_001_0	8		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	31		90					01	31		110	31		90					1	31	1
H6059	001	0	1	20	08	H6059_001_0	1		1																																																																																									
H6059	002	0	1	20	08	H6059_002_0	1		1																																																																																									
H6079	001	0	1	20	08	H6079_001_0	1		1																																																																																									
H6079	002	0	1	20	08	H6079_002_0	1		1																																																																																									
H6080	001	0	1	48	05	H6080_001_0	4	MM_3A	1	4	110110	1	1		2	1	1	1	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011100			1																						
H6132	001	0	1	01	01	H6132_001_0	6		1	1	110110	1	1	2		1	1	1	1	1	1																																																								111	30	60	90					01	30		100			90					1	31	2
H6169	001	0	1	09	04	H6169_001_0	5		2																																																																																									
H6169	011	0	1	09	04	H6169_011_0	4		2																																																																																									
H6169	012	0	1	09	04	H6169_012_0	4		2																																																																																									
H6169	013	0	1	09	04	H6169_013_0	4		2																																																																																									
H6169	016	0	1	09	04	H6169_016_0	4		2																																																																																									
H6169	021	0	1	09	04	H6169_021_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H6169	024	0	1	09	04	H6169_024_0	7	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H6169	031	0	1	09	04	H6169_031_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H6169	032	0	1	09	04	H6169_032_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H6169	033	0	1	09	04	H6169_033_0	6	5A	1	3	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	1						1							3							1			2																								
H6169	036	0	1	09	04	H6169_036_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H6169	801	0	1	09	04	H6169_801_0	1		2																																																																																									
H6169	802	0	1	09	04	H6169_802_0	1		1																																																																																									
H6169	803	0	1	09	04	H6169_803_0	1		1																																																																																									
H6178	001	0	1	01	01	H6178_001_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H6181	007	0	1	01	01	H6181_007_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	31	62	93					01	31		111	31	62	93					1	31	2
H6181	009	0	1	01	01	H6181_009_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							2	2400.00		2																								
H6229	005	0	1	48	05	H6229_005_0	1	MM_5E	1	4	110110	1	1		2	1	1	2	2			5	2																				5				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Generic Drugs		3								3	1	1111				1			2	1	001000	2		3		011111			1																						
H6231	001	0	1	20	08	H6231_001_0	1		1																																																																																									
H6231	002	0	1	20	08	H6231_002_0	1		1																																																																																									
H6237	002	0	1	01	01	H6237_002_0	8	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011000	1				1	1	0100	2			2	3							1			2																								
H6306	002	0	1	01	01	H6306_002_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
H6310	001	0	1	20	08	H6310_001_0	1		1																																																																																									
H6310	002	0	1	20	08	H6310_002_0	1		1																																																																																									
H6328	001	0	1	04	01	H6328_001_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		010000	2																								
H6328	002	0	1	04	01	H6328_002_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		010000	2																								
H6328	003	0	1	04	01	H6328_003_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		010000	2																								
H6328	005	0	1	04	01	H6328_005_0	7		2																																																																																									
H6328	801	0	1	04	01	H6328_801_0	4		1																																																																																									
H6328	802	0	1	04	01	H6328_802_0	4		1																																																																																									
H6328	803	0	1	04	01	H6328_803_0	5		2																																																																																									
H6328	804	0	1	04	01	H6328_804_0	5		2																																																																																									
H6360	001	0	1	18	06	H6360_001_0	3	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H6360	002	0	1	18	06	H6360_002_0	3	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H6360	004	0	1	18	06	H6360_004_0	1		2																																																																																									
H6360	006	0	1	18	06	H6360_006_0	3	5A5	1	3	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1							3							1			3																								
H6360	007	0	1	18	06	H6360_007_0	1		2																																																																																									
H6360	008	0	1	18	06	H6360_008_0	1		2																																																																																									
H6360	009	0	2	18	06	H6360_009_0	3	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H6360	010	0	1	18	06	H6360_010_0	5	5A5	1	3	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1							3							1			3																								
H6360	011	0	1	18	06	H6360_011_0	1		2																																																																																									
H6360	012	0	1	18	06	H6360_012_0	1		2																																																																																									
H6360	013	0	2	18	06	H6360_013_0	1		2																																																																																									
H6360	801	0		18	06	H6360_801_0	1		1																																																																																									
H6360	805	0		18	06	H6360_805_0	2		1																																																																																									
H6360	806	0		18	06	H6360_806_0	1		1																																																																																									
H6360	807	0		18	06	H6360_807_0	1		1																																																																																									
H6371	001	0	1	20	08	H6371_001_0	1		1																																																																																									
H6371	002	0	1	20	08	H6371_002_0	1		1																																																																																									
H6411	002	0	1	04	01	H6411_002_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6411	007	0	1	04	01	H6411_007_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6411	008	0	1	04	01	H6411_008_0	3		2																																																																																									
H6528	006	0	1	04	01	H6528_006_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H6528	016	0	1	04	01	H6528_016_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H6528	029	0	1	04	01	H6528_029_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H6528	030	0	1	04	01	H6528_030_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H6551	001	0	1	20	08	H6551_001_0	1		1																																																																																									
H6551	002	0	1	20	08	H6551_002_0	1		1																																																																																									
H6609	001	0	1	04	01	H6609_001_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H6609	003	0	1	04	01	H6609_003_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2							3							1			2																								
H6609	004	0	1	04	01	H6609_004_0	5		2																																																																																									
H6609	005	0	1	04	01	H6609_005_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H6609	006	0	1	04	01	H6609_006_0	5		2																																																																																									
H6609	009	0	1	04	01	H6609_009_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	011	0	1	04	01	H6609_011_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H6609	012	0	1	04	01	H6609_012_0	3		2																																																																																									
H6609	013	0	1	04	01	H6609_013_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	300.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H6609	017	0	1	04	01	H6609_017_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2							3							1			2																								
H6609	019	0	1	04	01	H6609_019_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H6609	029	0	1	04	01	H6609_029_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H6609	060	0	1	04	01	H6609_060_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H6609	062	0	1	04	01	H6609_062_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	065	0	1	04	01	H6609_065_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	066	0	1	04	01	H6609_066_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	070	0	1	04	01	H6609_070_0	3		2																																																																																									
H6609	073	0	1	04	01	H6609_073_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H6609	074	0	1	04	01	H6609_074_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	215.00	2	011000	1				2							3							1			2																								
H6609	075	0	1	04	01	H6609_075_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H6609	076	0	1	04	01	H6609_076_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	077	0	1	04	01	H6609_077_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	078	0	1	04	01	H6609_078_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	079	0	1	04	01	H6609_079_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H6609	080	0	1	04	01	H6609_080_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	081	0	1	04	01	H6609_081_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	082	0	1	04	01	H6609_082_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	083	0	1	04	01	H6609_083_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	084	0	1	04	01	H6609_084_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	085	0	1	04	01	H6609_085_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	086	0	1	04	01	H6609_086_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	087	0	1	04	01	H6609_087_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6609	801	0	1	04	01	H6609_801_0	3		1																																																																																									
H6609	802	0	1	04	01	H6609_802_0	2		2																																																																																									
H6609	803	0	1	04	01	H6609_803_0	2		1																																																																																									
H6609	805	0	2	04	01	H6609_805_0	1		1																																																																																									
H6609	806	0	2	04	01	H6609_806_0	1		2																																																																																									
H6609	807	0	2	04	01	H6609_807_0	1		1																																																																																									
H6609	814	0	1	04	01	H6609_814_0	2		1																																																																																									
H6609	816	0	1	04	01	H6609_816_0	2		2																																																																																									
H6622	001	0	1	01	01	H6622_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6622	002	0	1	01	01	H6622_002_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6622	003	0	1	01	01	H6622_003_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6622	801	0	1	01	01	H6622_801_0	2		1																																																																																									
H6622	802	0	1	01	01	H6622_802_0	2		2																																																																																									
H6622	803	0	1	01	01	H6622_803_0	2		1																																																																																									
H6623	001	0	1	01	01	H6623_001_0	7		1	1	110110	2	1	1		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	1
H6743	001	0	1	04	01	H6743_001_0	8	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H6743	002	0	1	04	01	H6743_002_0	5		2																																																																																									
H6743	003	0	1	04	01	H6743_003_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	1						1	1	0100	2			2	3							1			2																								
H6743	004	0	1	04	01	H6743_004_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H6743	005	0	1	04	01	H6743_005_0	8	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H6743	006	0	1	04	01	H6743_006_0	4		2																																																																																									
H6743	007	0	1	04	01	H6743_007_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H6745	001	0	1	01	01	H6745_001_0	8	3A	1	4	110110	1	1	2	2	1	1	1	2			3	2		1																						Generic, Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H6745	002	0	1	01	01	H6745_002_0	6		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H6745	003	0	1	01	01	H6745_003_0	6		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H6750	001	0	1	01	01	H6750_001_0	10	4C	1	4	110110	1	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		3								1	1	0110	2			1	3							1		011000	2																								
H6750	801	0	1	01	01	H6750_801_0	5		1																																																																																									
H6750	802	0	1	01	01	H6750_802_0	5		1																																																																																									
H6751	001	0	1	48	05	H6751_001_0	7	MM_2A	1	4	110110	1	1		2	1	1	1	2			2	2																	1							Generic Drugs, Brand Drugs		3								1	1	1111				1			1			2		3		011000			1																						
H6786	001	0	1	04	01	H6786_001_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	175.00	2	110001	1				2							3							1			2																								
H6786	801	0	1	04	01	H6786_801_0	4		1																																																																																									
H6786	802	0	1	04	01	H6786_802_0	4		2																																																																																									
H6786	803	0	1	04	01	H6786_803_0	4		1																																																																																									
H6801	002	0	1	01	01	H6801_002_0	10	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0100	2			1	3							1		011000	2																								
H6801	801	0	1	01	01	H6801_801_0	4		1																																																																																									
H6815	001	0	1	01	01	H6815_001_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H6815	002	0	1	01	01	H6815_002_0	4	5A7	1	4	110101	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								1	1	0110	2			2	3							1			2																								
H6859	001	0	1	01	01	H6859_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6859	002	0	1	01	01	H6859_002_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6859	003	0	1	01	01	H6859_003_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6859	004	0	1	01	01	H6859_004_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	175.00	2	011000	1				2	1	0110	2			1	3							1		011111	2																								
H6859	005	0	1	01	01	H6859_005_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H6859	006	0	1	01	01	H6859_006_0	3		2																																																																																									
H6864	001	0	1	02	01	H6864_001_0	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	2
H6864	002	0	1	02	01	H6864_002_0	7		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	2
H6881	002	0	1	04	01	H6881_002_0	5	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H6887	001	0	1	20	08	H6887_001_0	1		1																																																																																									
H6887	002	0	1	20	08	H6887_002_0	1		1																																																																																									
H6923	001	0	1	01	01	H6923_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H6923	005	0	1	01	01	H6923_005_0	6	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H6923	801	0	1	01	01	H6923_801_0	2		2																																																																																									
H6923	802	0	1	01	01	H6923_802_0	5		1																																																																																									
H6941	001	0	1	20	08	H6941_001_0	2		1																																																																																									
H6941	002	0	1	20	08	H6941_002_0	4		1																																																																																									
H6951	001	0	1	04	01	H6951_001_0	5		2																																																																																									
H6951	002	0	1	04	01	H6951_002_0	5	5A	1	4	110110	1	1	1	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	125.00	2	011001	1				1	1	0110	2			2	3							1			2																								
H6951	003	0	1	04	01	H6951_003_0	7	5A	1	4	110110	1	1	1	2	1	1	1	1	1	2	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H6952	002	0	1	01	01	H6952_002_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H6972	001	0	1	01	01	H6972_001_0	3	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H6988	001	0	1	01	01	H6988_001_0	6		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H7002	002	0	1	04	01	H7002_002_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H7003	001	0	1	20	08	H7003_001_0	1		1																																																																																									
H7003	002	0	1	20	08	H7003_002_0	1		1																																																																																									
H7006	001	0	1	04	01	H7006_001_0	6	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H7006	003	0	1	04	01	H7006_003_0	5	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	1						1	1	0100	2			2	3							1			2																								
H7006	004	0	1	04	01	H7006_004_0	4		2																																																																																									
H7006	005	0	1	04	01	H7006_005_0	6	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H7006	006	0	1	04	01	H7006_006_0	5		2																																																																																									
H7015	004	0	1	01	01	H7015_004_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
H7020	001	0	1	01	01	H7020_001_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H7020	801	0	1	01	01	H7020_801_0	2		1																																																																																									
H7020	802	0	1	02	01	H7020_802_0	2		1																																																																																									
H7020	803	0	1	01	01	H7020_803_0	2		1																																																																																									
H7020	804	0	1	02	01	H7020_804_0	2		1																																																																																									
H7020	805	0	1	01	01	H7020_805_0	2		2																																																																																									
H7020	806	0	1	02	01	H7020_806_0	2		2																																																																																									
H7086	001	0	1	01	01	H7086_001_0	5	2A	1	4	110110	1	1	1	2	1	1	1	1	1	1	2	2	1																							Generic, Brand		1		2	010000	2	2		0.00	2	1	0010	2			2	3							1			2																								
H7149	001	0	1	01	01	H7149_001_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7149	004	0	1	01	01	H7149_004_0	6	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7149	801	0	1	01	01	H7149_801_0	4		2																																																																																									
H7149	802	0	1	01	01	H7149_802_0	4		1																																																																																									
H7149	803	0	1	01	01	H7149_803_0	4		1																																																																																									
H7172	001	0	1	48	05	H7172_001_0	3	MM_5D	1	4	110110	1	1		2	1	1	1	2			5	2																				4				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs		3								3	1	1111				1			2	1	011000	2		3		011111			1																						
H7173	001	0	1	01	01	H7173_001_0	7	4E	1	4	110110	1	1	2	2	1	1	2	2			4	3			5																					Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H7187	003	0	1	01	01	H7187_003_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7187	009	0	1	01	01	H7187_009_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7187	801	0	1	02	01	H7187_801_0	2		1																																																																																									
H7188	003	0	1	04	01	H7188_003_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H7188	006	0	1	04	01	H7188_006_0	6	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	75.00	2	011000	1				2	1	0110	2			1	3							1		001111	2																								
H7195	001	0	1	20	08	H7195_001_0	1		1																																																																																									
H7195	002	0	1	20	08	H7195_002_0	1		1																																																																																									
H7200	006	0	1	01	01	H7200_006_0	5		1	1	110110	1	1	2		1	1	1	2																																																										111	31	62	93					01	31		111	31	62	93					1	31	2
H7200	007	0	1	01	01	H7200_007_0	5	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1							3							1			2																								
H7220	002	0	1	01	01	H7220_002_0	4		2																																																																																									
H7220	003	0	1	01	01	H7220_003_0	6	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H7220	004	0	1	02	01	H7220_004_0	7	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	2		2			1	3							1		010000	2																								
H7220	801	0	1	02	01	H7220_801_0	3		1																																																																																									
H7220	802	0	1	02	01	H7220_802_0	3		1																																																																																									
H7220	804	0	1	01	01	H7220_804_0	3		1																																																																																									
H7220	805	0	1	01	01	H7220_805_0	3		1																																																																																									
H7245	001	0	1	01	01	H7245_001_0	10	5B8	1	4	101101	1	1	1	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H7245	002	0	1	02	01	H7245_002_0	10	5B8	1	4	101101	1	1	1	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H7245	003	0	1	01	01	H7245_003_0	10	5B8	1	4	101101	1	1	1	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H7245	004	0	1	02	01	H7245_004_0	10	5B8	1	4	101101	1	1	1	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H7292	001	0	1	01	01	H7292_001_0	8		1	1	110110	1	1	2		1	1	1	1	1	1																																																								110	30		90					01	30		100			90					1	31	1
H7301	002	0	1	04	01	H7301_002_0	10	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7301	801	0	1	04	01	H7301_801_0	4		1																																																																																									
H7301	802	0	1	04	01	H7301_802_0	4		1																																																																																									
H7301	803	0	1	04	01	H7301_803_0	4		2																																																																																									
H7306	001	0	1	04	01	H7306_001_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7306	801	0	1	04	01	H7306_801_0	4		2																																																																																									
H7306	803	0	1	04	01	H7306_803_0	4		1																																																																																									
H7306	804	0	1	04	01	H7306_804_0	4		1																																																																																									
H7419	001	0	1	48	05	H7419_001_0	4	MM_3A	1	4	110110	1	1		2	1	1	1	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			1			2		3		011100			2																						
H7475	001	0	1	01	01	H7475_001_0	3		1	1	110100	2	1	2		1	1	1	2																																																										110	30		90					10		10									1	31	2
H7501	001	0	1	20	08	H7501_001_0	1		1																																																																																									
H7501	002	0	1	20	08	H7501_002_0	1		1																																																																																									
H7660	001	0	1	20	08	H7660_001_0	1		1																																																																																									
H7660	002	0	1	20	08	H7660_002_0	1		1																																																																																									
H7678	001	0	1	01	01	H7678_001_0	8	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			1	3							1		010000	2																								
H7728	001	0	1	04	01	H7728_001_0	5	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	170.00	2	110001	1				2							3							1			2																								
H7728	801	0	1	04	01	H7728_801_0	4		1																																																																																									
H7728	802	0	1	04	01	H7728_802_0	4		2																																																																																									
H7728	803	0	1	04	01	H7728_803_0	4		1																																																																																									
H7787	001	0	1	04	01	H7787_001_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H7787	002	0	1	04	01	H7787_002_0	2		2																																																																																									
H7811	001	0	1	01	01	H7811_001_0	3	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H7811	002	0	1	01	01	H7811_002_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H7855	001	0	1	20	08	H7855_001_0	1		1																																																																																									
H7855	002	0	1	20	08	H7855_002_0	1		1																																																																																									
H7885	001	0	1	48	05	H7885_001_0	4	MM_2A	1	4	110100	1	1		2	1	1	1	1	1	1	2	2																	1							Generic Drugs, Brand Drugs		3								1	1	1111				1			1			2		3		011000			1																						
H7890	001	0	1	48	05	H7890_001_0	5	MM_5D	1	4	110110	1	1		2	1	1	1	2			5	2																				4				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			1			2		3		011111			1																						
H7908	001	0	1	01	01	H7908_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H7908	801	0	1	01	01	H7908_801_0	1		2																																																																																									
H7908	802	0	1	01	01	H7908_802_0	1		1																																																																																									
H7917	008	0	1	04	01	H7917_008_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7917	009	0	1	04	01	H7917_009_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7917	010	0	1	04	01	H7917_010_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7917	011	0	1	04	01	H7917_011_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7917	012	0	1	04	01	H7917_012_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7917	013	0	1	04	01	H7917_013_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7917	014	0	1	04	01	H7917_014_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7917	015	0	1	04	01	H7917_015_0	6	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H7917	030	0	1	04	01	H7917_030_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H7917	031	0	1	04	01	H7917_031_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H7917	032	0	1	04	01	H7917_032_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H7917	033	0	1	04	01	H7917_033_0	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H7917	801	0	1	04	01	H7917_801_0	2		1																																																																																									
H7917	802	0	1	04	01	H7917_802_0	2		1																																																																																									
H7917	803	0	1	04	01	H7917_803_0	2		2																																																																																									
H7949	001	0	1	01	01	H7949_001_0	8	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H7949	801	0	1	01	01	H7949_801_0	2		2																																																																																									
H7949	803	0	1	01	01	H7949_803_0	2		1																																																																																									
H7949	804	0	1	01	01	H7949_804_0	2		1																																																																																									
H7971	001	0	1	04	01	H7971_001_0	7		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	31	1
H7971	801	0	1	04	01	H7971_801_0	8		2																																																																																									
H7971	802	0	1	04	01	H7971_802_0	5		1																																																																																									
H8016	001	0	1	48	05	H8016_001_0	4	MM_3A	1	4	110100	1	1		2	1	1	1	2			3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011100			1																						
H8046	001	0	1	48	05	H8046_001_0	6	MM_5D	1	4	110110	1	1		2	1	1	1	2			5	2																				4				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011111			1																						
H8064	002	0	1	04	01	H8064_002_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
H8091	002	0	1	04	01	H8091_002_0	17	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H8091	004	0	1	04	01	H8091_004_0	18	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	220.00	2	010000	1				1	1	0100	2			2	3							1			2																								
H8096	001	0	1	20	08	H8096_001_0	2		1																																																																																									
H8096	002	0	1	20	08	H8096_002_0	2		1																																																																																									
H8130	001	0	1	01	01	H8130_001_0	10	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			1	3							1		010000	2																								
H8145	001	0	1	09	04	H8145_001_0	7	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	125.00	2	011100	1				2							3							1			2																								
H8145	003	0	1	09	04	H8145_003_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	004	0	1	09	04	H8145_004_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	005	0	1	09	04	H8145_005_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	006	0	1	09	04	H8145_006_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	007	0	1	09	04	H8145_007_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	008	0	1	09	04	H8145_008_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	011	0	1	09	04	H8145_011_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	012	0	1	09	04	H8145_012_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	020	0	1	09	04	H8145_020_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	021	0	1	09	04	H8145_021_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	032	0	1	09	04	H8145_032_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	041	0	1	09	04	H8145_041_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	042	0	1	09	04	H8145_042_0	5		2																																																																																									
H8145	044	0	1	09	04	H8145_044_0	7		2																																																																																									
H8145	049	0	1	09	04	H8145_049_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	050	0	1	09	04	H8145_050_0	4		2																																																																																									
H8145	051	0	1	09	04	H8145_051_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	011100	1				2							3							1			2																								
H8145	052	0	1	09	04	H8145_052_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	053	0	1	09	04	H8145_053_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	055	0	1	09	04	H8145_055_0	3		2																																																																																									
H8145	061	0	1	09	04	H8145_061_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	063	0	1	09	04	H8145_063_0	9	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	069	0	1	09	04	H8145_069_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	071	0	1	09	04	H8145_071_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	075	0	1	09	04	H8145_075_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011000	1				2							3							1			2																								
H8145	078	0	1	09	04	H8145_078_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	079	0	1	09	04	H8145_079_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	084	0	1	09	04	H8145_084_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	087	0	1	09	04	H8145_087_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	80.00	2	011100	1				2							3							1			2																								
H8145	089	0	1	09	04	H8145_089_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H8145	091	0	1	09	04	H8145_091_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H8145	093	0	1	09	04	H8145_093_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	095	0	1	09	04	H8145_095_0	5		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H8145	097	0	1	09	04	H8145_097_0	5		2																																																																																									
H8145	103	0	1	09	04	H8145_103_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	104	0	1	09	04	H8145_104_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	300.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
H8145	108	0	1	09	04	H8145_108_0	3		2																																																																																									
H8145	110	0	1	09	04	H8145_110_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	115	0	1	09	04	H8145_115_0	3		2																																																																																									
H8145	120	0	1	09	04	H8145_120_0	7		2																																																																																									
H8145	121	0	1	09	04	H8145_121_0	3		2																																																																																									
H8145	122	0	1	09	04	H8145_122_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	123	0	1	09	04	H8145_123_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	124	0	1	09	04	H8145_124_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	125	0	1	09	04	H8145_125_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	126	0	1	09	04	H8145_126_0	3		2																																																																																									
H8145	127	0	1	09	04	H8145_127_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H8145	138	0	1	09	04	H8145_138_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2	1	0010	2			1	3							1		011111	2																								
H8145	139	0	1	09	04	H8145_139_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	225.00	2	010000	1				2							3							1			2																								
H8145	140	0	1	09	04	H8145_140_0	6		2																																																																																									
H8145	153	0	1	09	04	H8145_153_0	3		2																																																																																									
H8145	154	0	1	09	04	H8145_154_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8145	155	0	1	09	04	H8145_155_0	4		2																																																																																									
H8145	160	0	1	09	04	H8145_160_0	7		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H8145	161	0	1	09	04	H8145_161_0	6		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H8146	001	0	1	01	01	H8146_001_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H8189	001	0	1	01	01	H8189_001_0	6	4E	1	4	110110	1	1	2	2	1	1	2	2			4	3			5																					Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H8237	001	0	1	01	01	H8237_001_0	6	5A	1	4	110110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H8237	002	0	1	01	01	H8237_002_0	7		1	1	110110	2	1	2		1	1	1	2																																																										111	30	60	90					01	30		111	30	60	90					1	34	2
H8237	801	0	1	01	01	H8237_801_0	4		1																																																																																									
H8258	001	0	1	48	05	H8258_001_0	8	MM_5D	1	4	110110	1	1		2	1	1	1	2			5	2																				4				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs		3								3	1	1111				1			2	1	011000	2		3		011111			1																						
H8266	001	0	1	01	01	H8266_001_0	6	4A	1	4	110110	1	1	2	2	1	1	2	2			4	2			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	1	2	360.00	1	3							1		010000	2																								
H8393	001	0	1	04	01	H8393_001_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H8393	801	0	1	04	01	H8393_801_0	4		2																																																																																									
H8393	802	0	1	04	01	H8393_802_0	4		1																																																																																									
H8393	803	0	1	04	01	H8393_803_0	4		1																																																																																									
H8424	001	0	1	20	08	H8424_001_0	1		1																																																																																									
H8424	002	0	1	20	08	H8424_002_0	1		1																																																																																									
H8432	001	0	1	01	01	H8432_001_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	100.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H8432	801	0	1	01	01	H8432_801_0	5		1																																																																																									
H8452	001	0	1	48	05	H8452_001_0	4	MM_5D	1	4	110110	1	1		2	1	1	1	2			5	2																				4				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			1			2		3		011111			1																						
H8468	001	0	1	07	02	H8468_001_0	3		2																																																																																									
H8491	001	0	1	01	01	H8491_001_0	8		1	1	110110	1	1	2		1	1	1	1	1	1																																																								111	30	60	90					01	30		100			90					1	31	2
H8491	002	0	1	01	01	H8491_002_0	10	4A	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	010000	1				1	1	0110	2			2	3							1			2																								
H8552	001	0	1	04	01	H8552_001_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	149.00	2	110001	1				2							3							1			2																								
H8552	002	0	1	04	01	H8552_002_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	135.00	2	110001	1				2							3							1			2																								
H8552	003	0	1	04	01	H8552_003_0	8	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	179.00	2	110001	1				2							3							1			2																								
H8552	006	0	1	04	01	H8552_006_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	173.00	2	110001	1				2							3							1			2																								
H8552	007	0	1	04	01	H8552_007_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	145.00	2	110001	1				2							3							1			2																								
H8552	008	0	1	04	01	H8552_008_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	120.00	2	110001	1				2							3							1			2																								
H8552	009	0	1	04	01	H8552_009_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	149.00	2	110001	1				2							3							1			2																								
H8552	015	0	1	04	01	H8552_015_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	115.00	2	110001	1				2							3							1			2																								
H8552	017	0	1	04	01	H8552_017_0	6	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	125.00	2	110001	1				2							3							1			2																								
H8552	018	0	1	04	01	H8552_018_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	146.00	2	110001	1				2							3							1			2																								
H8552	801	0	1	04	01	H8552_801_0	2		1																																																																																									
H8552	802	0	1	04	01	H8552_802_0	2		2																																																																																									
H8552	803	0	1	04	01	H8552_803_0	2		1																																																																																									
H8554	001	0	1	01	01	H8554_001_0	7	5A	1	4	110110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H8578	001	0	1	01	01	H8578_001_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	1	2		1	3							1		010000	2																								
H8578	003	0	1	01	01	H8578_003_0	5		2																																																																																									
H8578	004	0	1	01	01	H8578_004_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	1	2		1	3							1		010000	2																								
H8578	007	0	1	01	01	H8578_007_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	1	2		1	3							1		010000	2																								
H8578	009	0	1	01	01	H8578_009_0	5		2																																																																																									
H8578	010	0	1	02	01	H8578_010_0	9	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	1	2		1	3							1		010000	2																								
H8578	012	0	1	01	01	H8578_012_0	8	4A	1	4	110110	1	1	2	1	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	1						1	2		1	2		2	3							1			2																								
H8578	801	0	1	02	01	H8578_801_0	3		1																																																																																									
H8578	802	0	1	02	01	H8578_802_0	3		2																																																																																									
H8578	803	0	1	02	01	H8578_803_0	3		1																																																																																									
H8604	001	0	1	04	01	H8604_001_0	9	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H8604	002	0	1	04	01	H8604_002_0	7		2																																																																																									
H8604	003	0	1	04	01	H8604_003_0	8	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H8604	004	0	1	04	01	H8604_004_0	7		2																																																																																									
H8604	005	0	1	04	01	H8604_005_0	10	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H8604	006	0	1	04	01	H8604_006_0	8	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
H8604	801	0	1	04	01	H8604_801_0	4		1																																																																																									
H8604	802	0	1	04	01	H8604_802_0	2		2																																																																																									
H8634	001	0	1	04	01	H8634_001_0	13	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H8634	002	0	1	04	01	H8634_002_0	12	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H8634	801	0	1	04	01	H8634_801_0	4		1																																																																																									
H8634	802	0	1	04	01	H8634_802_0	4		1																																																																																									
H8634	803	0	1	04	01	H8634_803_0	4		1																																																																																									
H8634	804	0	1	04	01	H8634_804_0	4		1																																																																																									
H8634	805	0	1	04	01	H8634_805_0	4		2																																																																																									
H8634	807	0	1	04	01	H8634_807_0	1		1																																																																																									
H8634	808	0	1	04	01	H8634_808_0	1		1																																																																																									
H8634	809	0	1	04	01	H8634_809_0	1		1																																																																																									
H8634	810	0	1	04	01	H8634_810_0	1		1																																																																																									
H8634	811	0	1	04	01	H8634_811_0	1		2																																																																																									
H8634	812	0	1	04	01	H8634_812_0	1		2																																																																																									
H8644	003	0	1	04	01	H8644_003_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8644	005	0	1	04	01	H8644_005_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	275.00	2	011000	1				2	1	0110	2			1	3							1		001111	2																								
H8649	003	0	1	02	01	H8649_003_0	17	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H8649	801	0	1	01	01	H8649_801_0	8		1																																																																																									
H8649	802	0	1	01	01	H8649_802_0	8		1																																																																																									
H8649	803	0	1	01	01	H8649_803_0	8		2																																																																																									
H8655	004	0	1	20	08	H8655_004_0	3		1																																																																																									
H8655	005	0	1	20	08	H8655_005_0	4		1																																																																																									
H8677	001	0	1	48	05	H8677_001_0	7	MM_5D	1	4	110110	1	1		2	1	1	1	2			5	2																				4				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011111			1																						
H8677	002	0	1	48	05	H8677_002_0	1	MM_5D	1	4	110110	1	1		2	1	1	1	2			5	2																				4				Generic Drugs, Brand Drugs, Non-Medicare Rx Generic Drugs, Non-Medicare Rx Brand Drugs, Non-Medicare OTC Drugs		3								1	1	1111				1			2	1	011000	2		3		011111			1																						
H8684	001	0	1	04	01	H8684_001_0	5	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
H8684	801	0	1	04	01	H8684_801_0	1		2																																																																																									
H8684	802	0	1	04	01	H8684_802_0	1		1																																																																																									
H8684	805	0	2	04	01	H8684_805_0	1		2																																																																																									
H8684	806	0	2	04	01	H8684_806_0	1		1																																																																																									
H8707	001	0	1	04	01	H8707_001_0	7	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8707	003	0	1	04	01	H8707_003_0	6	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8748	002	0	1	01	01	H8748_002_0	4	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H8764	001	0	1	01	01	H8764_001_0	5	5A	1	3	110110	1	1	2	1	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
H8764	002	0	1	01	01	H8764_002_0	4	5A	1	4	110110	1	1	2	1	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H8777	001	0	1	20	08	H8777_001_0	1		1																																																																																									
H8777	002	0	1	20	08	H8777_002_0	1		1																																																																																									
H8800	001	0	1	20	08	H8800_001_0	1		1																																																																																									
H8800	002	0	1	20	08	H8800_002_0	1		1																																																																																									
H8822	004	0	1	01	01	H8822_004_0	13	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H8822	005	0	1	01	01	H8822_005_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H8870	001	0	1	01	01	H8870_001_0	10	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			2	3							1			2																								
H8908	001	0	1	01	01	H8908_001_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8908	801	0	1	01	01	H8908_801_0	2		1																																																																																									
H8908	802	0	1	01	01	H8908_802_0	2		2																																																																																									
H8908	803	0	1	01	01	H8908_803_0	2		1																																																																																									
H8953	001	0	1	01	01	H8953_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8953	002	0	1	01	01	H8953_002_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8953	003	0	1	01	01	H8953_003_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8953	005	0	1	01	01	H8953_005_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8953	006	0	1	01	01	H8953_006_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8953	007	0	1	01	01	H8953_007_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	110.00	2	010000	1				2							3							1			2																								
H8953	008	0	1	01	01	H8953_008_0	8	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	80.00	2	010000	1				2							3							1			2																								
H8953	009	0	1	01	01	H8953_009_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8953	010	0	1	01	01	H8953_010_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8953	011	0	1	01	01	H8953_011_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8953	012	0	1	01	01	H8953_012_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H8953	014	0	1	01	01	H8953_014_0	7	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	010000	1				2							3							1			2																								
H8953	801	0	1	01	01	H8953_801_0	2		1																																																																																									
H8953	802	0	1	01	01	H8953_802_0	2		2																																																																																									
H8953	803	0	1	01	01	H8953_803_0	2		1																																																																																									
H8980	002	0	1	04	01	H8980_002_0	9	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H8980	004	0	1	04	01	H8980_004_0	4	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H8980	005	0	1	04	01	H8980_005_0	10	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H8980	006	0	1	04	01	H8980_006_0	7	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H8980	801	0	1	04	01	H8980_801_0	4		2																																																																																									
H8980	802	0	1	04	01	H8980_802_0	4		1																																																																																									
H8980	803	0	1	04	01	H8980_803_0	4		1																																																																																									
H8991	017	0	1	01	01	H8991_017_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			1	3							2	2800.00	010000	2																								
H8991	028	0	1	01	01	H8991_028_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							2	2500.00		2																								
H8991	029	0	1	01	01	H8991_029_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1	1	0010	2			1	3							2	2775.00	010000	2																								
H9001	001	0	1	01	01	H9001_001_0	6		2																																																																																									
H9001	013	0	1	02	01	H9001_013_0	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	015	0	1	01	01	H9001_015_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	019	0	1	01	01	H9001_019_0	8	3F	1	4	110110	1	1	2	2	1	1	1	2			3	3		6																						Preferred Generic, Preferred Brand, Non-Preferred Brand		1		1						1	2		1	2		2	2							1			2																								
H9001	029	1	1	01	01	H9001_029_1	5		2																																																																																									
H9001	029	2	1	01	01	H9001_029_2	5		2																																																																																									
H9001	029	4	1	01	01	H9001_029_4	5		2																																																																																									
H9001	029	5	1	01	01	H9001_029_5	5		2																																																																																									
H9001	029	6	1	01	01	H9001_029_6	5		2																																																																																									
H9001	030	1	1	01	01	H9001_030_1	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	030	2	1	01	01	H9001_030_2	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	030	4	1	01	01	H9001_030_4	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	030	5	1	01	01	H9001_030_5	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	031	1	1	01	01	H9001_031_1	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	031	2	1	01	01	H9001_031_2	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	031	4	1	01	01	H9001_031_4	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	031	5	1	01	01	H9001_031_5	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	031	6	1	01	01	H9001_031_6	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9001	032	1	1	01	01	H9001_032_1	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1	1	0010	2			2	3							1			2																								
H9001	032	2	1	01	01	H9001_032_2	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1	1	0010	2			2	3							1			2																								
H9001	032	4	1	01	01	H9001_032_4	8	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1	1	0010	2			2	3							1			2																								
H9001	032	5	1	01	01	H9001_032_5	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1	1	0010	2			2	3							1			2																								
H9001	032	6	1	01	01	H9001_032_6	7	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1	1	0010	2			2	3							1			2																								
H9001	801	0	1	01	01	H9001_801_0	4		2																																																																																									
H9001	803	0	1	01	01	H9001_803_0	4		1																																																																																									
H9001	804	0	1	02	01	H9001_804_0	4		1																																																																																									
H9003	001	0	1	01	01	H9003_001_0	10	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H9003	006	0	1	01	01	H9003_006_0	4	5A5	1	4	110110	2	1	2	2	2	1	2	2			6	3											1	1												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines		3								1	1	1110	2			1	3							1		111000	3																								
H9003	801	0	1	01	01	H9003_801_0	3		1																																																																																									
H9003	802	0	1	01	01	H9003_802_0	3		2																																																																																									
H9003	805	0	1	01	01	H9003_805_0	3		1																																																																																									
H9011	019	0	1	02	01	H9011_019_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H9011	020	0	1	01	01	H9011_020_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9011	801	0	1	01	01	H9011_801_0	2		1																																																																																									
H9011	802	0	1	01	01	H9011_802_0	2		2																																																																																									
H9011	803	0	1	01	01	H9011_803_0	2		1																																																																																									
H9011	805	0	2	01	01	H9011_805_0	2		1																																																																																									
H9047	001	0	1	01	01	H9047_001_0	10	5B8	1	4	101101	1	1	1	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H9047	013	0	2	01	01	H9047_013_0	10	5B8	1	4	101101	1	1	1	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H9047	024	0	1	02	01	H9047_024_0	10	5B8	1	4	101101	1	1	1	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
H9047	033	0	1	01	01	H9047_033_0	8		2																																																																																									
H9047	035	0	1	02	01	H9047_035_0	8		2																																																																																									
H9047	801	0	1	01	01	H9047_801_0	8		2																																																																																									
H9047	804	0	1	01	01	H9047_804_0	7		1																																																																																									
H9047	805	0	1	02	01	H9047_805_0	9		1																																																																																									
H9047	806	0	1	02	01	H9047_806_0	8		2																																																																																									
H9068	001	0	1	20	08	H9068_001_0	1		1																																																																																									
H9068	002	0	1	20	08	H9068_002_0	1		1																																																																																									
H9082	002	0	1	01	01	H9082_002_0	10	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9082	007	0	1	01	01	H9082_007_0	9		1	1	110110	1	1	2		1	1	1	2																																																										111	31	60	90					01	31		111	31	60	90					1	31	2
H9104	006	0	1	01	01	H9104_006_0	4	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		011000	2																								
H9110	002	0	1	01	01	H9110_002_0	8	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011000	1				1	1	0100	2			2	3							1			2																								
H9122	001	0	1	01	01	H9122_001_0	6	5A	1	4	110100	1	1	1	2	1	1	1	1	1	1	5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9122	002	0	1	01	01	H9122_002_0	6		1	1	110100	1	1	1		1	1	1	1	1	1																																																								110	30		90					01	30										1	31	1
H9122	003	0	1	01	01	H9122_003_0	6		1	1	110100	1	1	1		1	1	1	1	1	1																																																								110	30		90					01	30										1	31	1
H9190	001	0	1	01	01	H9190_001_0	5		1	1	110100	2	1	2		1	1	1	2																																																										111	30	60	90					01	30										1	31	1
H9190	002	0	1	01	01	H9190_002_0	4		1	1	110100	2	1	2		1	1	1	2																																																										111	30	60	90					01	30										1	31	1
H9190	003	0	1	01	01	H9190_003_0	4	5A7	1	4	110110	2	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	0.00	1						1	1	0110	2			2	3							1			2																								
H9190	004	0	1	01	01	H9190_004_0	4	5A7	1	4	110110	2	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		2	0.00	1						1	1	0110	2			2	3							1			2																								
H9190	005	0	1	01	01	H9190_005_0	4	5A	1	4	110110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	0.00	1						1	1	0110	2			2	3							1			2																								
H9190	006	0	1	01	01	H9190_006_0	4	5A	1	4	110110	2	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	0.00	1						1	1	0110	2			2	3							1			2																								
H9190	801	0	1	01	01	H9190_801_0	2		1																																																																																									
H9190	802	0	1	01	01	H9190_802_0	2		1																																																																																									
H9207	001	0	1	01	01	H9207_001_0	4		2																																																																																									
H9207	002	0	1	01	01	H9207_002_0	6	3A	1	4	110110	1	1	2	2	1	1	1	2			3	2		1																						Generic, Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9207	003	0	1	01	01	H9207_003_0	6	3A	1	4	110110	1	1	2	2	1	1	1	2			3	2		1																						Generic, Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
H9207	004	0	1	01	01	H9207_004_0	8		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		100			90					1	31	1
H9264	001	0	1	48	05	H9264_001_0	5	MM_3A	1	4	110110	1	1		2	1	1	1	1	1	1	3	2																		1						Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs		3								1	1	1111				1			2	2		2		3		011100			2																						
H9266	001	0	1	20	08	H9266_001_0	1		1																																																																																									
H9266	003	0	1	20	08	H9266_003_0	1		1																																																																																									
H9285	001	0	1	01	01	H9285_001_0	6	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H9285	002	0	1	01	01	H9285_002_0	6	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010000	2																								
H9285	003	0	1	01	01	H9285_003_0	6	4B	1	4	110110	1	1	2	2	1	1	1	1	1	1	4	3			2																					Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
H9302	001	0	1	01	01	H9302_001_0	11	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
H9302	003	0	1	01	01	H9302_003_0	10	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H9302	004	0	1	01	01	H9302_004_0	8		2																																																																																									
H9302	007	0	1	01	01	H9302_007_0	10	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	1	0010	2			2	3							1			2																								
H9302	010	0	1	01	01	H9302_010_0	10	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	1	0010	2			2	3							1			2																								
H9302	011	0	1	01	01	H9302_011_0	10	5A	1	4	110110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2	1	0010	2			2	3							1			2																								
H9302	801	0	1	01	01	H9302_801_0	4		1																																																																																									
H9385	002	0	1	01	01	H9385_002_0	6	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			2	3							1			2																								
H9385	003	0	1	01	01	H9385_003_0	6	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		110000	3																								
H9385	004	0	1	01	01	H9385_004_0	6	5A7	1	4	110110	1	1	2	2	1	1	1	2			6	4											1	9												Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		110000	3																								
H9385	805	0	1	01	01	H9385_805_0	4		2																																																																																									
H9385	807	0	1	01	01	H9385_807_0	4		1																																																																																									
H9385	808	0	1	01	01	H9385_808_0	4		1																																																																																									
H9412	002	0	1	04	01	H9412_002_0	4		2																																																																																									
H9412	003	0	1	04	01	H9412_003_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		010000	2																								
H9412	801	0	1	04	01	H9412_801_0	4		2																																																																																									
H9412	802	0	1	04	01	H9412_802_0	4		1																																																																																									
H9503	001	0	1	04	01	H9503_001_0	5	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
H9503	003	0	1	04	01	H9503_003_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011000	1				2	1	0110	2			1	3							1		011111	2																								
H9503	008	0	1	04	01	H9503_008_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	245.00	2	011000	1				2							3							1			2																								
H9503	009	0	1	04	01	H9503_009_0	5	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	250.00	2	011000	1				2							3							1			2																								
H9525	001	0	1	01	01	H9525_001_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	80.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H9525	002	0	1	01	01	H9525_002_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	65.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H9525	801	0	1	01	01	H9525_801_0	3		1																																																																																									
H9572	001	1	1	04	01	H9572_001_1	12	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9572	001	2	1	04	01	H9572_001_2	10	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9572	001	3	1	04	01	H9572_001_3	10	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9572	001	4	1	04	01	H9572_001_4	10	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9572	001	6	1	04	01	H9572_001_6	10	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9572	002	1	1	04	01	H9572_002_1	11		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	002	2	1	04	01	H9572_002_2	10		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	002	3	1	04	01	H9572_002_3	10		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	002	4	1	04	01	H9572_002_4	10		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	002	6	1	04	01	H9572_002_6	10		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	003	1	1	04	01	H9572_003_1	11	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H9572	003	2	1	04	01	H9572_003_2	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H9572	003	3	1	04	01	H9572_003_3	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H9572	003	4	1	04	01	H9572_003_4	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H9572	003	6	1	04	01	H9572_003_6	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H9572	004	1	1	04	01	H9572_004_1	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	004	2	1	04	01	H9572_004_2	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	004	3	1	04	01	H9572_004_3	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	004	4	1	04	01	H9572_004_4	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	004	6	1	04	01	H9572_004_6	9		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		110	31		90					1	31	2
H9572	801	0	1	04	01	H9572_801_0	5		1																																																																																									
H9572	802	0	1	04	01	H9572_802_0	5		2																																																																																									
H9572	803	0	1	04	01	H9572_803_0	5		1																																																																																									
H9572	804	0	1	04	01	H9572_804_0	5		2																																																																																									
H9592	001	0	1	20	08	H9592_001_0	1		1																																																																																									
H9592	002	0	1	20	08	H9592_002_0	1		1																																																																																									
H9615	002	0	1	04	01	H9615_002_0	7	4B7	1	4	110110	1	1	2	2	1	1	1	2			5	3				2		9																		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		000001	2																								
H9615	007	0	1	04	01	H9615_007_0	5	4B7	1	4	110110	1	1	2	2	1	1	1	2			5	3				2		9																		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		000001	2																								
H9615	008	0	1	04	01	H9615_008_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
H9615	802	0	1	04	01	H9615_802_0	3		1																																																																																									
H9615	807	0	1	04	01	H9615_807_0	2		1																																																																																									
H9670	004	0	1	04	01	H9670_004_0	9	4A7	1	3	110110	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2							3							1			2																								
H9670	801	0	1	04	01	H9670_801_0	10		2																																																																																									
H9670	802	0	1	04	01	H9670_802_0	9		1																																																																																									
H9670	803	0	1	04	01	H9670_803_0	9		1																																																																																									
H9685	001	0	1	01	01	H9685_001_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	31		90					01	31		100			90					1	31	1
H9699	001	0	1	01	01	H9699_001_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
H9725	001	0	1	01	01	H9725_001_0	5	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
H9725	801	0	1	01	01	H9725_801_0	2		1																																																																																									
H9725	802	0	1	02	01	H9725_802_0	2		1																																																																																									
H9725	803	0	1	01	01	H9725_803_0	2		1																																																																																									
H9725	804	0	1	02	01	H9725_804_0	2		1																																																																																									
H9725	805	0	1	01	01	H9725_805_0	2		2																																																																																									
H9725	806	0	1	02	01	H9725_806_0	2		2																																																																																									
H9730	001	0	1	01	01	H9730_001_0	3	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
H9730	002	0	1	02	01	H9730_002_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9788	001	0	1	07	02	H9788_001_0	2		2																																																																																									
H9788	002	0	1	07	02	H9788_002_0	1		2																																																																																									
H9788	003	0	1	07	02	H9788_003_0	2		2																																																																																									
H9788	004	0	1	07	02	H9788_004_0	1		2																																																																																									
H9788	801	0	1	07	02	H9788_801_0	2		2																																																																																									
H9788	802	0	1	07	02	H9788_802_0	2		2																																																																																									
H9830	001	0	1	20	08	H9830_001_0	1		1																																																																																									
H9830	002	0	1	20	08	H9830_002_0	1		1																																																																																									
H9834	001	0	1	01	01	H9834_001_0	4	5A	1	3	110100	1	1	2	1	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	30.00	2	011000	1				2							3							1			2																								
H9834	003	0	1	01	01	H9834_003_0	7	5A	1	3	110100	1	1	2	1	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	90.00	2	011000	1				2							3							1			2																								
H9834	004	0	1	01	01	H9834_004_0	5		2																																																																																									
H9834	005	0	1	01	01	H9834_005_0	4		2																																																																																									
H9847	001	0	1	04	01	H9847_001_0	9	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9847	005	0	1	04	01	H9847_005_0	10	5A	1	4	101110	1	1	2	2	1	1	1	1	1	1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9847	801	0	1	04	01	H9847_801_0	3		2																																																																																									
H9847	802	0	1	04	01	H9847_802_0	3		1																																																																																									
H9847	803	0	1	04	01	H9847_803_0	3		1																																																																																									
H9847	804	0	1	04	01	H9847_804_0	3		2																																																																																									
H9847	805	0	1	04	01	H9847_805_0	3		1																																																																																									
H9847	806	0	1	04	01	H9847_806_0	3		1																																																																																									
H9857	001	0	1	01	01	H9857_001_0	4	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
H9859	001	0	1	02	01	H9859_001_0	4		2																																																																																									
H9859	002	0	1	02	01	H9859_002_0	6	4B7	1	4	110110	1	1	2	2	1	1	1	2			5	3				2		9																		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		000001	2																								
H9859	013	0	1	02	01	H9859_013_0	6	4B7	1	4	110110	1	1	2	2	1	1	1	2			5	3				2		9																		Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								2	1	0110	2			1	3							1		000001	2																								
H9859	802	0	1	02	01	H9859_802_0	2		1																																																																																									
H9886	001	0	1	01	01	H9886_001_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	60.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H9886	801	0	1	01	01	H9886_801_0	4		1																																																																																									
H9915	001	0	1	01	01	H9915_001_0	4	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
H9947	001	0	1	04	01	H9947_001_0	7	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	125.00	2	110001	1				2							3							1			2																								
H9947	801	0	1	04	01	H9947_801_0	2		1																																																																																									
H9947	802	0	1	04	01	H9947_802_0	2		2																																																																																									
H9947	803	0	1	04	01	H9947_803_0	2		1																																																																																									
H9947	805	0	2	04	01	H9947_805_0	3		1																																																																																									
H9954	001	0	1	01	01	H9954_001_0	7	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	75.00	2	111001	1				2	1	0100	2			2	3							1			2																								
H9954	801	0	1	01	01	H9954_801_0	4		1																																																																																									
H9998	001	0	1	20	08	H9998_001_0	1		1																																																																																									
H9998	002	0	1	20	08	H9998_002_0	1		1																																																																																									
R3175	003	0	1	31	11	R3175_003_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
R3175	801	0	1	31	11	R3175_801_0	2		1																																																																																									
R3175	802	0	1	31	11	R3175_802_0	2		2																																																																																									
R3332	001	0	1	31	11	R3332_001_0	8	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	30.00	1						1							3							1			2																								
R3444	008	0	1	31	11	R3444_008_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
R3444	009	0	1	31	11	R3444_009_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R3444	011	0	1	31	11	R3444_011_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
R3444	012	0	1	31	11	R3444_012_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R5287	001	0	1	31	11	R5287_001_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R5287	002	0	1	31	11	R5287_002_0	4		2																																																																																									
R5287	003	0	1	31	11	R5287_003_0	8		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
R5342	001	0	1	31	11	R5342_001_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R5342	002	0	1	31	11	R5342_002_0	5		2																																																																																									
R5342	801	0	1	31	11	R5342_801_0	3		1																																																																																									
R5342	802	0	1	31	11	R5342_802_0	3		2																																																																																									
R5342	803	0	1	31	11	R5342_803_0	3		1																																																																																									
R5826	001	0	1	31	11	R5826_001_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	40.00	2	011100	1				2							3							1			2																								
R5826	002	0	1	31	11	R5826_002_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
R5826	003	0	1	31	11	R5826_003_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
R5826	005	0	1	31	11	R5826_005_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
R5826	006	0	1	31	11	R5826_006_0	6		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
R5826	007	0	1	31	11	R5826_007_0	3	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	011100	1				2							3							1			2																								
R5826	008	0	1	31	11	R5826_008_0	3	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
R5826	009	0	1	31	11	R5826_009_0	6		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
R5826	010	0	1	31	11	R5826_010_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
R5826	011	0	1	31	11	R5826_011_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
R5826	012	0	1	31	11	R5826_012_0	8	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
R5826	013	0	1	31	11	R5826_013_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
R5826	014	0	1	31	11	R5826_014_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	175.00	2	011000	1				2							3							1			2																								
R5826	018	0	1	31	11	R5826_018_0	4		2																																																																																									
R5826	021	0	1	31	11	R5826_021_0	3		2																																																																																									
R5826	023	0	1	31	11	R5826_023_0	5		2																																																																																									
R5826	026	0	1	31	11	R5826_026_0	5		2																																																																																									
R5826	053	0	1	31	11	R5826_053_0	4		2																																																																																									
R5826	062	0	1	31	11	R5826_062_0	3		2																																																																																									
R5826	063	0	1	31	11	R5826_063_0	3		2																																																																																									
R5826	064	0	1	31	11	R5826_064_0	7		2																																																																																									
R5826	065	0	1	31	11	R5826_065_0	4		2																																																																																									
R5826	066	0	1	31	11	R5826_066_0	4		2																																																																																									
R5826	067	0	1	31	11	R5826_067_0	4		2																																																																																									
R5826	068	0	1	31	11	R5826_068_0	4		2																																																																																									
R5826	069	0	1	31	11	R5826_069_0	4		2																																																																																									
R5826	070	0	1	31	11	R5826_070_0	10		2																																																																																									
R5826	074	0	1	31	11	R5826_074_0	4	5A	1	4	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	011100	1				2	1	0110	2			1	3							1		011111	2																								
R5826	077	0	1	31	11	R5826_077_0	6	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	150.00	2	011100	1				2							3							1			2																								
R5826	078	0	1	31	11	R5826_078_0	4		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
R5826	079	0	1	31	11	R5826_079_0	3		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
R5826	081	0	1	31	11	R5826_081_0	3		1	1	110110	1	1	1		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
R5826	091	0	1	31	11	R5826_091_0	4	5A	1	3	110101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011100	1				2							3							1			2																								
R5826	801	0	1	31	11	R5826_801_0	4		1																																																																																									
R5826	802	0	1	31	11	R5826_802_0	3		1																																																																																									
R5826	803	0	1	31	11	R5826_803_0	3		1																																																																																									
R5826	804	0	1	31	11	R5826_804_0	3		1																																																																																									
R5826	805	0	1	31	11	R5826_805_0	4		1																																																																																									
R5826	806	0	1	31	11	R5826_806_0	3		1																																																																																									
R5826	807	0	1	31	11	R5826_807_0	3		1																																																																																									
R5826	808	0	1	31	11	R5826_808_0	3		1																																																																																									
R5826	809	0	1	31	11	R5826_809_0	4		1																																																																																									
R5826	810	0	1	31	11	R5826_810_0	3		1																																																																																									
R5826	811	0	1	31	11	R5826_811_0	3		1																																																																																									
R5826	812	0	1	31	11	R5826_812_0	3		1																																																																																									
R5826	813	0	1	31	11	R5826_813_0	3		1																																																																																									
R5826	814	0	1	31	11	R5826_814_0	3		1																																																																																									
R5826	815	0	1	31	11	R5826_815_0	5		2																																																																																									
R5826	816	0	1	31	11	R5826_816_0	3		2																																																																																									
R5826	817	0	1	31	11	R5826_817_0	3		2																																																																																									
R5826	818	0	1	31	11	R5826_818_0	3		2																																																																																									
R5826	819	0	1	31	11	R5826_819_0	3		2																																																																																									
R5826	820	0	1	31	11	R5826_820_0	3		2																																																																																									
R5826	821	0	1	31	11	R5826_821_0	3		2																																																																																									
R5826	822	0	1	31	11	R5826_822_0	3		2																																																																																									
R5826	823	0	1	31	11	R5826_823_0	3		2																																																																																									
R5826	824	0	1	31	11	R5826_824_0	3		2																																																																																									
R5826	825	0	1	31	11	R5826_825_0	3		2																																																																																									
R5826	826	0	1	31	11	R5826_826_0	3		2																																																																																									
R5826	827	0	1	31	11	R5826_827_0	3		2																																																																																									
R5826	828	0	1	31	11	R5826_828_0	3		2																																																																																									
R5826	831	0	1	31	11	R5826_831_0	3		1																																																																																									
R5826	832	0	1	31	11	R5826_832_0	3		1																																																																																									
R5826	833	0	1	31	11	R5826_833_0	3		1																																																																																									
R5826	834	0	1	31	11	R5826_834_0	3		1																																																																																									
R5826	835	0	1	31	11	R5826_835_0	4		1																																																																																									
R5826	836	0	1	31	11	R5826_836_0	3		1																																																																																									
R5826	837	0	1	31	11	R5826_837_0	3		1																																																																																									
R5826	838	0	1	31	11	R5826_838_0	3		1																																																																																									
R5826	839	0	1	31	11	R5826_839_0	3		1																																																																																									
R5826	840	0	1	31	11	R5826_840_0	3		1																																																																																									
R5826	841	0	1	31	11	R5826_841_0	3		1																																																																																									
R5826	842	0	1	31	11	R5826_842_0	3		1																																																																																									
R5826	843	0	1	31	11	R5826_843_0	3		1																																																																																									
R5826	844	0	1	31	11	R5826_844_0	3		1																																																																																									
R5941	007	0	1	31	11	R5941_007_0	7		2																																																																																									
R5941	008	0	1	31	11	R5941_008_0	8	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	120.00	2	110001	1				2							3							1			2																								
R5941	009	0	1	31	11	R5941_009_0	8	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		2	100.00	2	110001	1				2							3							1			2																								
R6801	008	0	1	31	11	R6801_008_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
R6801	009	0	1	31	11	R6801_009_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R6801	011	0	1	31	11	R6801_011_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
R6801	012	0	1	31	11	R6801_012_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R7439	001	0	1	31	11	R7439_001_0	10	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R7439	003	0	1	31	11	R7439_003_0	9	4A	1	4	110110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
R7439	006	0	1	31	11	R7439_006_0	8		2																																																																																									
R7439	801	0	1	31	11	R7439_801_0	5		1																																																																																									
R7439	802	0	1	31	11	R7439_802_0	4		1																																																																																									
R7439	805	0	1	31	11	R7439_805_0	4		2																																																																																									
R7439	806	0	1	31	11	R7439_806_0	4		2																																																																																									
R7444	001	0	1	31	11	R7444_001_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R9896	008	0	1	31	11	R9896_008_0	6		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
R9896	009	0	1	31	11	R9896_009_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R9896	012	0	1	31	11	R9896_012_0	6	5A	1	4	110101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
R9896	021	0	1	31	11	R9896_021_0	5		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	1
S0064	001	0		29	10	S0064_001_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	002	0		29	10	S0064_002_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	003	0		29	10	S0064_003_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	004	0		29	10	S0064_004_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	005	0		29	10	S0064_005_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	006	0		29	10	S0064_006_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	007	0		29	10	S0064_007_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	008	0		29	10	S0064_008_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	009	0		29	10	S0064_009_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	010	0		29	10	S0064_010_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	011	0		29	10	S0064_011_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	012	0		29	10	S0064_012_0	2	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	013	0		29	10	S0064_013_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	014	0		29	10	S0064_014_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	015	0		29	10	S0064_015_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	016	0		29	10	S0064_016_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	017	0		29	10	S0064_017_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	018	0		29	10	S0064_018_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	019	0		29	10	S0064_019_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	020	0		29	10	S0064_020_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	021	0		29	10	S0064_021_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	022	0		29	10	S0064_022_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	023	0		29	10	S0064_023_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	024	0		29	10	S0064_024_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	025	0		29	10	S0064_025_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	026	0		29	10	S0064_026_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	027	0		29	10	S0064_027_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	028	0		29	10	S0064_028_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	029	0		29	10	S0064_029_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	030	0		29	10	S0064_030_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	031	0		29	10	S0064_031_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	032	0		29	10	S0064_032_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	033	0		29	10	S0064_033_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	034	0		29	10	S0064_034_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	035	0		29	10	S0064_035_0	1	5A	1	2	101100	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0064	036	0		29	10	S0064_036_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	037	0		29	10	S0064_037_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	038	0		29	10	S0064_038_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	039	0		29	10	S0064_039_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	040	0		29	10	S0064_040_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	041	0		29	10	S0064_041_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	042	0		29	10	S0064_042_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	043	0		29	10	S0064_043_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	044	0		29	10	S0064_044_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	045	0		29	10	S0064_045_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	046	0		29	10	S0064_046_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	047	0		29	10	S0064_047_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	048	0		29	10	S0064_048_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	049	0		29	10	S0064_049_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	050	0		29	10	S0064_050_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	051	0		29	10	S0064_051_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	052	0		29	10	S0064_052_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	053	0		29	10	S0064_053_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	054	0		29	10	S0064_054_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	055	0		29	10	S0064_055_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	056	0		29	10	S0064_056_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	057	0		29	10	S0064_057_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	058	0		29	10	S0064_058_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	059	0		29	10	S0064_059_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	060	0		29	10	S0064_060_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	061	0		29	10	S0064_061_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	062	0		29	10	S0064_062_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	063	0		29	10	S0064_063_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	064	0		29	10	S0064_064_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	065	0		29	10	S0064_065_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	066	0		29	10	S0064_066_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	067	0		29	10	S0064_067_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	068	0		29	10	S0064_068_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	069	0		29	10	S0064_069_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0064	070	0		29	10	S0064_070_0	1	5A	1	4	101100	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S0128	003	0		29	10	S0128_003_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	004	0		29	10	S0128_004_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	005	0		29	10	S0128_005_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	006	0		29	10	S0128_006_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	007	0		29	10	S0128_007_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	008	0		29	10	S0128_008_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	009	0		29	10	S0128_009_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	010	0		29	10	S0128_010_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	011	0		29	10	S0128_011_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	012	0		29	10	S0128_012_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	013	0		29	10	S0128_013_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	014	0		29	10	S0128_014_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	015	0		29	10	S0128_015_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	016	0		29	10	S0128_016_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	017	0		29	10	S0128_017_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	018	0		29	10	S0128_018_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	019	0		29	10	S0128_019_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	020	0		29	10	S0128_020_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	021	0		29	10	S0128_021_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	022	0		29	10	S0128_022_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	023	0		29	10	S0128_023_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	024	0		29	10	S0128_024_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	025	0		29	10	S0128_025_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	026	0		29	10	S0128_026_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	027	0		29	10	S0128_027_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	028	0		29	10	S0128_028_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	029	0		29	10	S0128_029_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	030	0		29	10	S0128_030_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	031	0		29	10	S0128_031_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	032	0		29	10	S0128_032_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	033	0		29	10	S0128_033_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	034	0		29	10	S0128_034_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0128	035	0		29	10	S0128_035_0	6	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0197	005	0		29	10	S0197_005_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S0197	809	0		29	10	S0197_809_0	1		1																																																																																									
S0197	810	0		29	10	S0197_810_0	1		1																																																																																									
S0197	815	0		29	10	S0197_815_0	1		1																																																																																									
S0197	816	0		29	10	S0197_816_0	1		1																																																																																									
S0197	817	0		29	10	S0197_817_0	1		1																																																																																									
S0197	818	0		29	10	S0197_818_0	1		1																																																																																									
S0197	821	0		29	10	S0197_821_0	1		1																																																																																									
S0197	822	0		29	10	S0197_822_0	1		1																																																																																									
S0223	003	0		29	10	S0223_003_0	6	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	001	0		29	10	S0522_001_0	4	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	002	0		29	10	S0522_002_0	7	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	004	0		29	10	S0522_004_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	006	0		29	10	S0522_006_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	008	0		29	10	S0522_008_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	010	0		29	10	S0522_010_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	012	0		29	10	S0522_012_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	014	0		29	10	S0522_014_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	016	0		29	10	S0522_016_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	018	0		29	10	S0522_018_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	020	0		29	10	S0522_020_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	022	0		29	10	S0522_022_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	024	0		29	10	S0522_024_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	026	0		29	10	S0522_026_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	028	0		29	10	S0522_028_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	030	0		29	10	S0522_030_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	032	0		29	10	S0522_032_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	034	0		29	10	S0522_034_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	036	0		29	10	S0522_036_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	037	0		29	10	S0522_037_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	038	0		29	10	S0522_038_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	039	0		29	10	S0522_039_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	040	0		29	10	S0522_040_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	041	0		29	10	S0522_041_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	042	0		29	10	S0522_042_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	043	0		29	10	S0522_043_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	044	0		29	10	S0522_044_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	045	0		29	10	S0522_045_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	046	0		29	10	S0522_046_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0522	047	0		29	10	S0522_047_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	5				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S0586	801	0		29	10	S0586_801_0	2		1																																																																																									
S0655	801	0		29	10	S0655_801_0	2		1																																																																																									
S0655	802	0		29	10	S0655_802_0	2		1																																																																																									
S1030	001	0		29	10	S1030_001_0	3	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S1030	006	0		29	10	S1030_006_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S1030	801	0		29	10	S1030_801_0	1		1																																																																																									
S1030	802	0		29	10	S1030_802_0	1		1																																																																																									
S1030	803	0		29	10	S1030_803_0	1		1																																																																																									
S1030	804	0		29	10	S1030_804_0	1		1																																																																																									
S1140	001	0		29	10	S1140_001_0	1	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S1140	801	0		29	10	S1140_801_0	1		1																																																																																									
S1480	801	0		29	10	S1480_801_0	1		1																																																																																									
S1822	801	0		29	10	S1822_801_0	1		1																																																																																									
S1822	802	0		29	10	S1822_802_0	1		1																																																																																									
S2321	002	0		29	10	S2321_002_0	2	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S2321	005	0		29	10	S2321_005_0	2	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	290.00	1						1							3							1			2																								
S2468	003	0		29	10	S2468_003_0	4	5B8	1	2	101110	1	1	1		1	1	1	2			6	5											2		3									1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier	1																																																		
S2468	004	0		29	10	S2468_004_0	6	5B8	1	4	101110	1	1	1	2	1	1	1	2			6	5											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S2468	801	0		29	10	S2468_801_0	1		1																																																																																									
S2468	802	0		29	10	S2468_802_0	1		1																																																																																									
S2505	001	0		29	10	S2505_001_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S2505	003	0		29	10	S2505_003_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S2505	005	0		29	10	S2505_005_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S2505	007	0		29	10	S2505_007_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S2505	009	0		29	10	S2505_009_0	1	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S2505	010	0		29	10	S2505_010_0	1	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S2874	001	0		29	10	S2874_001_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S2874	004	0		29	10	S2874_004_0	5	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S2874	801	0		29	10	S2874_801_0	1		1																																																																																									
S2874	802	0		29	10	S2874_802_0	1		1																																																																																									
S2874	803	0		29	10	S2874_803_0	1		1																																																																																									
S2893	001	0		29	10	S2893_001_0	1	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	225.00	2	011000	1				2							3							1			2																								
S2893	003	0		29	10	S2893_003_0	1	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			1	3							1		011000	2																								
S2893	801	0		29	10	S2893_801_0	1		1																																																																																									
S2893	802	0		29	10	S2893_802_0	1		1																																																																																									
S3389	802	0		29	10	S3389_802_0	3		1																																																																																									
S3389	803	0		29	10	S3389_803_0	3		1																																																																																									
S3440	004	0		29	10	S3440_004_0	6	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	75.00	2	011000	1				2							3							1			2																								
S3474	801	0		29	10	S3474_801_0	4		1																																																																																									
S3474	802	0		29	10	S3474_802_0	4		1																																																																																									
S3474	803	0		29	10	S3474_803_0	4		1																																																																																									
S3474	804	0		29	10	S3474_804_0	4		1																																																																																									
S3474	805	0		29	10	S3474_805_0	4		1																																																																																									
S3474	806	0		29	10	S3474_806_0	4		1																																																																																									
S3474	807	0		29	10	S3474_807_0	4		1																																																																																									
S3474	808	0		29	10	S3474_808_0	4		1																																																																																									
S3474	809	0		29	10	S3474_809_0	4		1																																																																																									
S3474	810	0		29	10	S3474_810_0	4		1																																																																																									
S3474	811	0		29	10	S3474_811_0	4		1																																																																																									
S3474	812	0		29	10	S3474_812_0	4		1																																																																																									
S3474	813	0		29	10	S3474_813_0	4		1																																																																																									
S3474	814	0		29	10	S3474_814_0	4		1																																																																																									
S3474	815	0		29	10	S3474_815_0	4		1																																																																																									
S3474	816	0		29	10	S3474_816_0	4		1																																																																																									
S3474	817	0		29	10	S3474_817_0	4		1																																																																																									
S3474	818	0		29	10	S3474_818_0	4		1																																																																																									
S3474	819	0		29	10	S3474_819_0	4		1																																																																																									
S3474	820	0		29	10	S3474_820_0	4		1																																																																																									
S3474	821	0		29	10	S3474_821_0	4		1																																																																																									
S3474	822	0		29	10	S3474_822_0	4		1																																																																																									
S3474	823	0		29	10	S3474_823_0	4		1																																																																																									
S3474	824	0		29	10	S3474_824_0	4		1																																																																																									
S3474	825	0		29	10	S3474_825_0	4		1																																																																																									
S3474	826	0		29	10	S3474_826_0	4		1																																																																																									
S3474	827	0		29	10	S3474_827_0	4		1																																																																																									
S3474	828	0		29	10	S3474_828_0	4		1																																																																																									
S3474	829	0		29	10	S3474_829_0	4		1																																																																																									
S3474	830	0		29	10	S3474_830_0	4		1																																																																																									
S3474	831	0		29	10	S3474_831_0	4		1																																																																																									
S3474	832	0		29	10	S3474_832_0	4		1																																																																																									
S3474	833	0		29	10	S3474_833_0	4		1																																																																																									
S3474	834	0		29	10	S3474_834_0	4		1																																																																																									
S3474	835	0		29	10	S3474_835_0	4		1																																																																																									
S3474	836	0		29	10	S3474_836_0	4		1																																																																																									
S3474	837	0		29	10	S3474_837_0	4		1																																																																																									
S3474	838	0		29	10	S3474_838_0	4		1																																																																																									
S3474	839	0		29	10	S3474_839_0	4		1																																																																																									
S3474	840	0		29	10	S3474_840_0	4		1																																																																																									
S3474	841	0		29	10	S3474_841_0	4		1																																																																																									
S3474	842	0		29	10	S3474_842_0	4		1																																																																																									
S3474	843	0		29	10	S3474_843_0	4		1																																																																																									
S3474	844	0		29	10	S3474_844_0	4		1																																																																																									
S3474	845	0		29	10	S3474_845_0	4		1																																																																																									
S3474	846	0		29	10	S3474_846_0	4		1																																																																																									
S3474	847	0		29	10	S3474_847_0	4		1																																																																																									
S3474	848	0		29	10	S3474_848_0	4		1																																																																																									
S3474	849	0		29	10	S3474_849_0	4		1																																																																																									
S3474	850	0		29	10	S3474_850_0	4		1																																																																																									
S3474	851	0		29	10	S3474_851_0	4		1																																																																																									
S3474	852	0		29	10	S3474_852_0	4		1																																																																																									
S3474	853	0		29	10	S3474_853_0	4		1																																																																																									
S3474	854	0		29	10	S3474_854_0	4		1																																																																																									
S3521	001	0		29	10	S3521_001_0	4	4C	1	2	101101	1	1	2		1	1	1	2			4	3			3																			2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S3521	801	0		29	10	S3521_801_0	1		1																																																																																									
S3875	802	0		29	10	S3875_802_0	3		1																																																																																									
S3875	803	0		29	10	S3875_803_0	3		1																																																																																									
S3994	801	0		29	10	S3994_801_0	1		1																																																																																									
S3994	802	0		29	10	S3994_802_0	1		1																																																																																									
S4219	001	0		29	10	S4219_001_0	1	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S4219	003	0		29	10	S4219_003_0	1	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S4219	801	0		29	10	S4219_801_0	1		1																																																																																									
S4219	802	0		29	10	S4219_802_0	1		1																																																																																									
S4802	012	0		29	10	S4802_012_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S4802	013	0		29	10	S4802_013_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S4802	014	0		29	10	S4802_014_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S4802	020	0		29	10	S4802_020_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S4802	021	0		29	10	S4802_021_0	3	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S4802	801	0		29	10	S4802_801_0	1		1																																																																																									
S4802	805	0		29	10	S4802_805_0	1		1																																																																																									
S4802	806	0		29	10	S4802_806_0	1		1																																																																																									
S4802	807	0		29	10	S4802_807_0	1		1																																																																																									
S4802	809	0		29	10	S4802_809_0	1		1																																																																																									
S4802	810	0		29	10	S4802_810_0	1		1																																																																																									
S5351	801	0		29	10	S5351_801_0	2		1																																																																																									
S5540	002	0		29	10	S5540_002_0	5	5A	1	3	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	145.00	1						2							3							1			2																								
S5540	004	0		29	10	S5540_004_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
S5540	801	0		29	10	S5540_801_0	1		1																																																																																									
S5552	003	0		29	10	S5552_003_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5552	004	0		29	10	S5552_004_0	6	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5552	005	0		29	10	S5552_005_0	7	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5552	801	0		29	10	S5552_801_0	1		1																																																																																									
S5552	802	0		29	10	S5552_802_0	1		1																																																																																									
S5552	803	0		29	10	S5552_803_0	1		1																																																																																									
S5569	006	0		29	10	S5569_006_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5569	007	0		29	10	S5569_007_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5580	003	0		29	10	S5580_003_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	120.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5580	006	0		29	10	S5580_006_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5580	801	0		29	10	S5580_801_0	1		1																																																																																									
S5580	802	0		29	10	S5580_802_0	1		1																																																																																									
S5580	805	0		29	10	S5580_805_0	1		1																																																																																									
S5580	806	0		29	10	S5580_806_0	1		1																																																																																									
S5584	001	0		29	10	S5584_001_0	6	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	195.00	2	011000	1				2							3							1			2																								
S5584	002	0		29	10	S5584_002_0	7	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
S5584	801	0		29	10	S5584_801_0	5		1																																																																																									
S5584	802	0		29	10	S5584_802_0	5		1																																																																																									
S5588	802	0		29	10	S5588_802_0	1		1																																																																																									
S5588	803	0		29	10	S5588_803_0	1		1																																																																																									
S5593	002	0		29	10	S5593_002_0	5	5A	1	2	110110	1	1	2		1	1	2	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5593	003	0		29	10	S5593_003_0	5	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
S5593	007	0		29	10	S5593_007_0	5	5A	1	2	110110	1	1	2		1	1	2	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5593	008	0		29	10	S5593_008_0	5	4A	1	4	110110	1	1	2	2	1	1	2	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		010000	2																								
S5593	801	0		29	10	S5593_801_0	4		1																																																																																									
S5593	802	0		29	10	S5593_802_0	4		1																																																																																									
S5593	805	0		29	10	S5593_805_0	4		1																																																																																									
S5593	806	0		29	10	S5593_806_0	4		1																																																																																									
S5596	001	0		29	10	S5596_001_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	003	0		29	10	S5596_003_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	005	0		29	10	S5596_005_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	006	0		29	10	S5596_006_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	007	0		29	10	S5596_007_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	009	0		29	10	S5596_009_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	010	0		29	10	S5596_010_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	011	0		29	10	S5596_011_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	013	0		29	10	S5596_013_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	014	0		29	10	S5596_014_0	3	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	015	0		29	10	S5596_015_0	3	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	017	0		29	10	S5596_017_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	018	0		29	10	S5596_018_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	019	0		29	10	S5596_019_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	033	0		29	10	S5596_033_0	4	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	034	0		29	10	S5596_034_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	035	0		29	10	S5596_035_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	043	0		29	10	S5596_043_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	044	0		29	10	S5596_044_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	045	0		29	10	S5596_045_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	046	0		29	10	S5596_046_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	056	0		29	10	S5596_056_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	057	0		29	10	S5596_057_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	058	0		29	10	S5596_058_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	059	0		29	10	S5596_059_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	060	0		29	10	S5596_060_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	061	0		29	10	S5596_061_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	062	0		29	10	S5596_062_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5596	063	0		29	10	S5596_063_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5596	064	0		29	10	S5596_064_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5596	803	0		29	10	S5596_803_0	1		1																																																																																									
S5596	804	0		29	10	S5596_804_0	1		1																																																																																									
S5601	002	0		29	10	S5601_002_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	003	0		29	10	S5601_003_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	004	0		29	10	S5601_004_0	3	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	005	0		29	10	S5601_005_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	006	0		29	10	S5601_006_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	007	0		29	10	S5601_007_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	008	0		29	10	S5601_008_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	009	0		29	10	S5601_009_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	010	0		29	10	S5601_010_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	011	0		29	10	S5601_011_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	012	0		29	10	S5601_012_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	013	0		29	10	S5601_013_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	014	0		29	10	S5601_014_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	015	0		29	10	S5601_015_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	016	0		29	10	S5601_016_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	017	0		29	10	S5601_017_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	018	0		29	10	S5601_018_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	019	0		29	10	S5601_019_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	020	0		29	10	S5601_020_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	021	0		29	10	S5601_021_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	022	0		29	10	S5601_022_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	023	0		29	10	S5601_023_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	024	0		29	10	S5601_024_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	025	0		29	10	S5601_025_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	026	0		29	10	S5601_026_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	027	0		29	10	S5601_027_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	028	0		29	10	S5601_028_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	029	0		29	10	S5601_029_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	030	0		29	10	S5601_030_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	031	0		29	10	S5601_031_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	032	0		29	10	S5601_032_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	033	0		29	10	S5601_033_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	034	0		29	10	S5601_034_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	035	0		29	10	S5601_035_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	036	0		29	10	S5601_036_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	037	0		29	10	S5601_037_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	038	0		29	10	S5601_038_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	040	0		29	10	S5601_040_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	041	0		29	10	S5601_041_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	042	0		29	10	S5601_042_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	044	0		29	10	S5601_044_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	045	0		29	10	S5601_045_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	046	0		29	10	S5601_046_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	048	0		29	10	S5601_048_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	049	0		29	10	S5601_049_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	050	0		29	10	S5601_050_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	051	0		29	10	S5601_051_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	052	0		29	10	S5601_052_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	053	0		29	10	S5601_053_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	054	0		29	10	S5601_054_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	055	0		29	10	S5601_055_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	056	0		29	10	S5601_056_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	057	0		29	10	S5601_057_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	058	0		29	10	S5601_058_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	059	0		29	10	S5601_059_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	060	0		29	10	S5601_060_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	061	0		29	10	S5601_061_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	062	0		29	10	S5601_062_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	063	0		29	10	S5601_063_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	064	0		29	10	S5601_064_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	065	0		29	10	S5601_065_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	066	0		29	10	S5601_066_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	067	0		29	10	S5601_067_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	068	0		29	10	S5601_068_0	2	4A	1	2	110110	1	1	2		1	1	1	2			4	3			1																			1	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5601	107	0		29	10	S5601_107_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	108	0		29	10	S5601_108_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	109	0		29	10	S5601_109_0	2	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5601	110	0		29	10	S5601_110_0	4	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	111	0		29	10	S5601_111_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	112	0		29	10	S5601_112_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	113	0		29	10	S5601_113_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	114	0		29	10	S5601_114_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	115	0		29	10	S5601_115_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	116	0		29	10	S5601_116_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	117	0		29	10	S5601_117_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	118	0		29	10	S5601_118_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	119	0		29	10	S5601_119_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	120	0		29	10	S5601_120_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	121	0		29	10	S5601_121_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	122	0		29	10	S5601_122_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	123	0		29	10	S5601_123_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	124	0		29	10	S5601_124_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	125	0		29	10	S5601_125_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	126	0		29	10	S5601_126_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	127	0		29	10	S5601_127_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	128	0		29	10	S5601_128_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	129	0		29	10	S5601_129_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	130	0		29	10	S5601_130_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	131	0		29	10	S5601_131_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	132	0		29	10	S5601_132_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	133	0		29	10	S5601_133_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	134	0		29	10	S5601_134_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	135	0		29	10	S5601_135_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	136	0		29	10	S5601_136_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	137	0		29	10	S5601_137_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	138	0		29	10	S5601_138_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	139	0		29	10	S5601_139_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	140	0		29	10	S5601_140_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	141	0		29	10	S5601_141_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	142	0		29	10	S5601_142_0	3	4A	1	4	101110	1	1	2	2	1	1	1	2			4	3			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5601	801	0		29	10	S5601_801_0	1		1																																																																																									
S5601	802	0		29	10	S5601_802_0	1		1																																																																																									
S5601	803	0		29	10	S5601_803_0	1		1																																																																																									
S5601	804	0		29	10	S5601_804_0	1		1																																																																																									
S5601	805	0		29	10	S5601_805_0	1		1																																																																																									
S5601	806	0		29	10	S5601_806_0	1		1																																																																																									
S5601	807	0		29	10	S5601_807_0	1		1																																																																																									
S5601	808	0		29	10	S5601_808_0	1		1																																																																																									
S5601	809	0		29	10	S5601_809_0	1		1																																																																																									
S5601	810	0		29	10	S5601_810_0	1		1																																																																																									
S5601	811	0		29	10	S5601_811_0	1		1																																																																																									
S5609	001	0		29	10	S5609_001_0	4	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	1						1							3							1			2																								
S5609	002	0		29	10	S5609_002_0	5	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		010000	2																								
S5609	802	0		29	10	S5609_802_0	2		1																																																																																									
S5617	003	0		29	10	S5617_003_0	4	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	008	0		29	10	S5617_008_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	013	0		29	10	S5617_013_0	5	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	018	0		29	10	S5617_018_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	053	0		29	10	S5617_053_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	068	0		29	10	S5617_068_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	088	0		29	10	S5617_088_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	103	0		29	10	S5617_103_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	108	0		29	10	S5617_108_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	113	0		29	10	S5617_113_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	118	0		29	10	S5617_118_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	123	0		29	10	S5617_123_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	128	0		29	10	S5617_128_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	133	0		29	10	S5617_133_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	138	0		29	10	S5617_138_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	143	0		29	10	S5617_143_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	148	0		29	10	S5617_148_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	153	0		29	10	S5617_153_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	158	0		29	10	S5617_158_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	163	0		29	10	S5617_163_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	172	0		29	10	S5617_172_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	176	0		29	10	S5617_176_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	177	0		29	10	S5617_177_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	178	0		29	10	S5617_178_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	179	0		29	10	S5617_179_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	181	0		29	10	S5617_181_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	182	0		29	10	S5617_182_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	183	0		29	10	S5617_183_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	184	0		29	10	S5617_184_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	185	0		29	10	S5617_185_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	187	0		29	10	S5617_187_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	188	0		29	10	S5617_188_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	189	0		29	10	S5617_189_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	192	0		29	10	S5617_192_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	195	0		29	10	S5617_195_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	198	0		29	10	S5617_198_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	214	0		29	10	S5617_214_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	215	0		29	10	S5617_215_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	216	0		29	10	S5617_216_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	217	0		29	10	S5617_217_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	218	0		29	10	S5617_218_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	219	0		29	10	S5617_219_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	220	0		29	10	S5617_220_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	221	0		29	10	S5617_221_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	222	0		29	10	S5617_222_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	223	0		29	10	S5617_223_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	224	0		29	10	S5617_224_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	225	0		29	10	S5617_225_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	226	0		29	10	S5617_226_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	227	0		29	10	S5617_227_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5617	228	0		29	10	S5617_228_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	229	0		29	10	S5617_229_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	230	0		29	10	S5617_230_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	231	0		29	10	S5617_231_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	232	0		29	10	S5617_232_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	233	0		29	10	S5617_233_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	234	0		29	10	S5617_234_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	235	0		29	10	S5617_235_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	236	0		29	10	S5617_236_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	237	0		29	10	S5617_237_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	238	0		29	10	S5617_238_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	239	0		29	10	S5617_239_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	240	0		29	10	S5617_240_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	241	0		29	10	S5617_241_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	242	0		29	10	S5617_242_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	243	0		29	10	S5617_243_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	244	0		29	10	S5617_244_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	245	0		29	10	S5617_245_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011110	2																								
S5617	246	0		29	10	S5617_246_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	247	0		29	10	S5617_247_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	248	0		29	10	S5617_248_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	249	0		29	10	S5617_249_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	250	0		29	10	S5617_250_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	251	0		29	10	S5617_251_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	252	0		29	10	S5617_252_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	253	0		29	10	S5617_253_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	254	0		29	10	S5617_254_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	255	0		29	10	S5617_255_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	256	0		29	10	S5617_256_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	257	0		29	10	S5617_257_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	258	0		29	10	S5617_258_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	259	0		29	10	S5617_259_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	260	0		29	10	S5617_260_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	261	0		29	10	S5617_261_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	262	0		29	10	S5617_262_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	263	0		29	10	S5617_263_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	264	0		29	10	S5617_264_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	265	0		29	10	S5617_265_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	266	0		29	10	S5617_266_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	267	0		29	10	S5617_267_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	268	0		29	10	S5617_268_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	269	0		29	10	S5617_269_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	270	0		29	10	S5617_270_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	271	0		29	10	S5617_271_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	272	0		29	10	S5617_272_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	273	0		29	10	S5617_273_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	274	0		29	10	S5617_274_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	275	0		29	10	S5617_275_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	276	0		29	10	S5617_276_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	277	0		29	10	S5617_277_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	278	0		29	10	S5617_278_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	279	0		29	10	S5617_279_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			2	3							1			2																								
S5617	801	0		29	10	S5617_801_0	1		1																																																																																									
S5617	802	0		29	10	S5617_802_0	1		1																																																																																									
S5617	805	0		29	10	S5617_805_0	1		1																																																																																									
S5617	806	0		29	10	S5617_806_0	1		1																																																																																									
S5660	104	0		29	10	S5660_104_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	105	0		29	10	S5660_105_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	106	0		29	10	S5660_106_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	107	0		29	10	S5660_107_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	108	0		29	10	S5660_108_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	109	0		29	10	S5660_109_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	110	0		29	10	S5660_110_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	111	0		29	10	S5660_111_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	112	0		29	10	S5660_112_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	113	0		29	10	S5660_113_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	114	0		29	10	S5660_114_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	115	0		29	10	S5660_115_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	116	0		29	10	S5660_116_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	117	0		29	10	S5660_117_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	118	0		29	10	S5660_118_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	119	0		29	10	S5660_119_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	120	0		29	10	S5660_120_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	121	0		29	10	S5660_121_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	122	0		29	10	S5660_122_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	123	0		29	10	S5660_123_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	124	0		29	10	S5660_124_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	125	0		29	10	S5660_125_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	126	0		29	10	S5660_126_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	127	0		29	10	S5660_127_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	128	0		29	10	S5660_128_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	129	0		29	10	S5660_129_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	130	0		29	10	S5660_130_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	131	0		29	10	S5660_131_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	132	0		29	10	S5660_132_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	133	0		29	10	S5660_133_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	134	0		29	10	S5660_134_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	135	0		29	10	S5660_135_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	136	0		29	10	S5660_136_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	137	0		29	10	S5660_137_0	1	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5660	172	0		29	10	S5660_172_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	176	0		29	10	S5660_176_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	180	0		29	10	S5660_180_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	181	0		29	10	S5660_181_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	182	0		29	10	S5660_182_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	183	0		29	10	S5660_183_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	184	0		29	10	S5660_184_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	185	0		29	10	S5660_185_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	186	0		29	10	S5660_186_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	187	0		29	10	S5660_187_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	190	0		29	10	S5660_190_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	192	0		29	10	S5660_192_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	194	0		29	10	S5660_194_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	195	0		29	10	S5660_195_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	196	0		29	10	S5660_196_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	197	0		29	10	S5660_197_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	198	0		29	10	S5660_198_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	199	0		29	10	S5660_199_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	202	0		29	10	S5660_202_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	203	0		29	10	S5660_203_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	204	0		29	10	S5660_204_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	205	0		29	10	S5660_205_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	206	0		29	10	S5660_206_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	207	0		29	10	S5660_207_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	208	0		29	10	S5660_208_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	209	0		29	10	S5660_209_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	210	0		29	10	S5660_210_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	211	0		29	10	S5660_211_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	212	0		29	10	S5660_212_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	213	0		29	10	S5660_213_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	214	0		29	10	S5660_214_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	215	0		29	10	S5660_215_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	216	0		29	10	S5660_216_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	217	0		29	10	S5660_217_0	1	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5660	801	0		29	10	S5660_801_0	1		1																																																																																									
S5660	802	0		29	10	S5660_802_0	1		1																																																																																									
S5660	803	0		29	10	S5660_803_0	1		1																																																																																									
S5660	804	0		29	10	S5660_804_0	1		1																																																																																									
S5660	806	0		29	10	S5660_806_0	1		1																																																																																									
S5660	807	0		29	10	S5660_807_0	1		1																																																																																									
S5660	809	0		29	10	S5660_809_0	1		1																																																																																									
S5660	810	0		29	10	S5660_810_0	1		1																																																																																									
S5670	030	0		29	10	S5670_030_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	036	0		29	10	S5670_036_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	042	0		29	10	S5670_042_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	048	0		29	10	S5670_048_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	054	0		29	10	S5670_054_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	060	0		29	10	S5670_060_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	066	0		29	10	S5670_066_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	072	0		29	10	S5670_072_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	078	0		29	10	S5670_078_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	084	0		29	10	S5670_084_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	090	0		29	10	S5670_090_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	096	0		29	10	S5670_096_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	102	0		29	10	S5670_102_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	108	0		29	10	S5670_108_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	114	0		29	10	S5670_114_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	120	0		29	10	S5670_120_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	126	0		29	10	S5670_126_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	132	0		29	10	S5670_132_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	138	0		29	10	S5670_138_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	144	0		29	10	S5670_144_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	150	0		29	10	S5670_150_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5670	801	0		29	10	S5670_801_0	1		1																																																																																									
S5670	802	0		29	10	S5670_802_0	1		1																																																																																									
S5670	809	0		29	10	S5670_809_0	1		1																																																																																									
S5670	810	0		29	10	S5670_810_0	1		1																																																																																									
S5670	811	0		29	10	S5670_811_0	1		1																																																																																									
S5670	812	0		29	10	S5670_812_0	1		1																																																																																									
S5670	815	0		29	10	S5670_815_0	1		1																																																																																									
S5670	816	0		29	10	S5670_816_0	1		1																																																																																									
S5674	005	0		29	10	S5674_005_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	011	0		29	10	S5674_011_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	017	0		29	10	S5674_017_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	023	0		29	10	S5674_023_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	029	0		29	10	S5674_029_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	035	0		29	10	S5674_035_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	041	0		29	10	S5674_041_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	047	0		29	10	S5674_047_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	053	0		29	10	S5674_053_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	059	0		29	10	S5674_059_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	065	0		29	10	S5674_065_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	071	0		29	10	S5674_071_0	2	5A	1	4	110110	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		1	3							1		010110	2																								
S5674	801	0		29	10	S5674_801_0	2		1																																																																																									
S5674	802	0		29	10	S5674_802_0	2		1																																																																																									
S5674	809	0		29	10	S5674_809_0	2		1																																																																																									
S5674	810	0		29	10	S5674_810_0	2		1																																																																																									
S5674	811	0		29	10	S5674_811_0	2		1																																																																																									
S5674	812	0		29	10	S5674_812_0	2		1																																																																																									
S5674	815	0		29	10	S5674_815_0	2		1																																																																																									
S5674	816	0		29	10	S5674_816_0	2		1																																																																																									
S5715	001	0		29	10	S5715_001_0	11	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	275.00	2	011000	1				1	1	0100	2			2	3							1			2																								
S5715	002	0		29	10	S5715_002_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011111	2																								
S5715	003	0		29	10	S5715_003_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011000	1				1	1	0100	2			2	3							1			2																								
S5715	004	0		29	10	S5715_004_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011111	2																								
S5715	005	0		29	10	S5715_005_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	200.00	2	011000	1				1	1	0100	2			2	3							1			2																								
S5715	006	0		29	10	S5715_006_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011111	2																								
S5715	010	0		29	10	S5715_010_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	275.00	2	011000	1				1	1	0100	2			2	3							1			2																								
S5715	011	0		29	10	S5715_011_0	9	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011111	2																								
S5715	012	0		29	10	S5715_012_0	7	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1							3							1			2																								
S5715	013	0		29	10	S5715_013_0	7	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1							3							1			2																								
S5715	014	0		29	10	S5715_014_0	7	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1							3							1			2																								
S5715	015	0		29	10	S5715_015_0	7	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		1						1							3							1			2																								
S5715	801	0		29	10	S5715_801_0	2		1																																																																																									
S5715	802	0		29	10	S5715_802_0	2		1																																																																																									
S5715	803	0		29	10	S5715_803_0	2		1																																																																																									
S5715	804	0		29	10	S5715_804_0	2		1																																																																																									
S5715	805	0		29	10	S5715_805_0	2		1																																																																																									
S5715	806	0		29	10	S5715_806_0	2		1																																																																																									
S5715	807	0		29	10	S5715_807_0	2		1																																																																																									
S5715	808	0		29	10	S5715_808_0	2		1																																																																																									
S5715	809	0		29	10	S5715_809_0	2		1																																																																																									
S5715	810	0		29	10	S5715_810_0	2		1																																																																																									
S5715	811	0		29	10	S5715_811_0	2		1																																																																																									
S5715	812	0		29	10	S5715_812_0	2		1																																																																																									
S5715	813	0		29	10	S5715_813_0	2		1																																																																																									
S5715	814	0		29	10	S5715_814_0	2		1																																																																																									
S5715	815	0		29	10	S5715_815_0	2		1																																																																																									
S5715	816	0		29	10	S5715_816_0	2		1																																																																																									
S5726	013	0		29	10	S5726_013_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5726	014	0		29	10	S5726_014_0	5	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5726	015	0		29	10	S5726_015_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		011100	2																								
S5726	805	0		29	10	S5726_805_0	1		1																																																																																									
S5743	001	0		29	10	S5743_001_0	4	4C	1	3	110110	1	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		2	160.00	1						2							3							1			2																								
S5743	004	0		29	10	S5743_004_0	3	4C	1	4	110110	1	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		3								2	1	0110	2			1	3							1		011000	2																								
S5743	802	0		29	10	S5743_802_0	1		1																																																																																									
S5743	805	0		29	10	S5743_805_0	1		1																																																																																									
S5753	006	0		29	10	S5753_006_0	2	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	170.00	1						3							3							1			2																								
S5753	007	0		29	10	S5753_007_0	2	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								3	1	0110	2			1	3							1		011000	2																								
S5753	801	0		29	10	S5753_801_0	1		1																																																																																									
S5753	803	0		29	10	S5753_803_0	1		1																																																																																									
S5755	006	0		29	10	S5755_006_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	120.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	007	0		29	10	S5755_007_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	110.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	008	0		29	10	S5755_008_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	100.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	009	0		29	10	S5755_009_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	80.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	010	0		29	10	S5755_010_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	80.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	011	0		29	10	S5755_011_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	012	0		29	10	S5755_012_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	80.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	013	0		29	10	S5755_013_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	014	0		29	10	S5755_014_0	3	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	80.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	015	0		29	10	S5755_015_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	40.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	016	0		29	10	S5755_016_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	110.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	017	0		29	10	S5755_017_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	80.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	018	0		29	10	S5755_018_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	020	0		29	10	S5755_020_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	021	0		29	10	S5755_021_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	50.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	022	0		29	10	S5755_022_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	023	0		29	10	S5755_023_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	024	0		29	10	S5755_024_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	025	0		29	10	S5755_025_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	90.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	026	0		29	10	S5755_026_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	028	0		29	10	S5755_028_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	20.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	029	0		29	10	S5755_029_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	90.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	030	0		29	10	S5755_030_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	110.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	031	0		29	10	S5755_031_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	90.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	032	0		29	10	S5755_032_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	90.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	033	0		29	10	S5755_033_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	50.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	034	0		29	10	S5755_034_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	80.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	035	0		29	10	S5755_035_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	60.00	2	011000	1				1	1	0110	2			2	3							1			2																								
S5755	038	0		29	10	S5755_038_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	039	0		29	10	S5755_039_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	073	0		29	10	S5755_073_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	074	0		29	10	S5755_074_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	075	0		29	10	S5755_075_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	076	0		29	10	S5755_076_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	077	0		29	10	S5755_077_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	078	0		29	10	S5755_078_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	079	0		29	10	S5755_079_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	080	0		29	10	S5755_080_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	081	0		29	10	S5755_081_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	082	0		29	10	S5755_082_0	3	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	083	0		29	10	S5755_083_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	084	0		29	10	S5755_084_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	085	0		29	10	S5755_085_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	086	0		29	10	S5755_086_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	087	0		29	10	S5755_087_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	088	0		29	10	S5755_088_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	089	0		29	10	S5755_089_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	091	0		29	10	S5755_091_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	092	0		29	10	S5755_092_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	093	0		29	10	S5755_093_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	094	0		29	10	S5755_094_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	095	0		29	10	S5755_095_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	096	0		29	10	S5755_096_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	097	0		29	10	S5755_097_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	098	0		29	10	S5755_098_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	099	0		29	10	S5755_099_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	100	0		29	10	S5755_100_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	101	0		29	10	S5755_101_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	102	0		29	10	S5755_102_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	103	0		29	10	S5755_103_0	2	5A	1	2	101110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5755	106	0		29	10	S5755_106_0	2	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5755	801	0		29	10	S5755_801_0	1		1																																																																																									
S5755	802	0		29	10	S5755_802_0	1		1																																																																																									
S5755	805	0		29	10	S5755_805_0	1		1																																																																																									
S5755	806	0		29	10	S5755_806_0	1		1																																																																																									
S5766	002	0		29	10	S5766_002_0	4	5A	1	3	101100	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	255.00	1						2							3							1			2																								
S5766	003	0		29	10	S5766_003_0	4	5A	1	4	101100	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
S5768	005	0		29	10	S5768_005_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	007	0		29	10	S5768_007_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	008	0		29	10	S5768_008_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	009	0		29	10	S5768_009_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	010	0		29	10	S5768_010_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	012	0		29	10	S5768_012_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	015	0		29	10	S5768_015_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	016	0		29	10	S5768_016_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	017	0		29	10	S5768_017_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	018	0		29	10	S5768_018_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	021	0		29	10	S5768_021_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	031	0		29	10	S5768_031_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	038	0		29	10	S5768_038_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	039	0		29	10	S5768_039_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	040	0		29	10	S5768_040_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	041	0		29	10	S5768_041_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	042	0		29	10	S5768_042_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	043	0		29	10	S5768_043_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	045	0		29	10	S5768_045_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	048	0		29	10	S5768_048_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	082	0		29	10	S5768_082_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	083	0		29	10	S5768_083_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	117	0		29	10	S5768_117_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	118	0		29	10	S5768_118_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	119	0		29	10	S5768_119_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	122	0		29	10	S5768_122_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	123	0		29	10	S5768_123_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	125	0		29	10	S5768_125_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	126	0		29	10	S5768_126_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	127	0		29	10	S5768_127_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	128	0		29	10	S5768_128_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	129	0		29	10	S5768_129_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	130	0		29	10	S5768_130_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	131	0		29	10	S5768_131_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	132	0		29	10	S5768_132_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	133	0		29	10	S5768_133_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	134	0		29	10	S5768_134_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	135	0		29	10	S5768_135_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	136	0		29	10	S5768_136_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	137	0		29	10	S5768_137_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	138	0		29	10	S5768_138_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	139	0		29	10	S5768_139_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	140	0		29	10	S5768_140_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	141	0		29	10	S5768_141_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	142	0		29	10	S5768_142_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	143	0		29	10	S5768_143_0	5	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	144	0		29	10	S5768_144_0	5	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	145	0		29	10	S5768_145_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	146	0		29	10	S5768_146_0	5	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	147	0		29	10	S5768_147_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	148	0		29	10	S5768_148_0	5	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	149	0		29	10	S5768_149_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	150	0		29	10	S5768_150_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	151	0		29	10	S5768_151_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	152	0		29	10	S5768_152_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	153	0		29	10	S5768_153_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	154	0		29	10	S5768_154_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	155	0		29	10	S5768_155_0	4	5A	1	4	101100	1	1	2	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5768	158	0		29	10	S5768_158_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	159	0		29	10	S5768_159_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	160	0		29	10	S5768_160_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	161	0		29	10	S5768_161_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	162	0		29	10	S5768_162_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5768	163	0		29	10	S5768_163_0	3	3F	1	2	101110	1	1	2		1	1	1	1		1	3	3		6																				2	2	Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S5775	001	0		29	10	S5775_001_0	2	5A	1	4	101110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	1	2		2	3							1			2																								
S5775	002	0		29	10	S5775_002_0	2	5A	1	3	101110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	299.00	1						2							3							1			2																								
S5775	801	0		29	10	S5775_801_0	1		1																																																																																									
S5775	802	0		29	10	S5775_802_0	1		1																																																																																									
S5795	002	0		29	10	S5795_002_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011000	2																								
S5795	003	0		29	10	S5795_003_0	2	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				1							3							1			2																								
S5795	804	0		29	10	S5795_804_0	2		1																																																																																									
S5795	809	0		29	10	S5795_809_0	2		1																																																																																									
S5795	811	0		29	10	S5795_811_0	2		1																																																																																									
S5795	812	0		29	10	S5795_812_0	2		1																																																																																									
S5805	001	0		29	10	S5805_001_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5805	803	0		29	10	S5805_803_0	1		1																																																																																									
S5805	804	0		29	10	S5805_804_0	1		1																																																																																									
S5805	807	0		29	10	S5805_807_0	1		1																																																																																									
S5805	808	0		29	10	S5805_808_0	1		1																																																																																									
S5805	809	0		29	10	S5805_809_0	1		1																																																																																									
S5805	810	0		29	10	S5805_810_0	1		1																																																																																									
S5805	811	0		29	10	S5805_811_0	1		1																																																																																									
S5805	812	0		29	10	S5805_812_0	1		1																																																																																									
S5805	813	0		29	10	S5805_813_0	1		1																																																																																									
S5805	814	0		29	10	S5805_814_0	1		1																																																																																									
S5805	815	0		29	10	S5805_815_0	1		1																																																																																									
S5805	816	0		29	10	S5805_816_0	1		1																																																																																									
S5805	817	0		29	10	S5805_817_0	1		1																																																																																									
S5810	035	0		29	10	S5810_035_0	3	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	036	0		29	10	S5810_036_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	037	0		29	10	S5810_037_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	038	0		29	10	S5810_038_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	039	0		29	10	S5810_039_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	040	0		29	10	S5810_040_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	041	0		29	10	S5810_041_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	042	0		29	10	S5810_042_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	043	0		29	10	S5810_043_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	044	0		29	10	S5810_044_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	045	0		29	10	S5810_045_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	046	0		29	10	S5810_046_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	047	0		29	10	S5810_047_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	048	0		29	10	S5810_048_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	049	0		29	10	S5810_049_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	050	0		29	10	S5810_050_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	051	0		29	10	S5810_051_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	052	0		29	10	S5810_052_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	053	0		29	10	S5810_053_0	2	4A7	1	2	110101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	054	0		29	10	S5810_054_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	055	0		29	10	S5810_055_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	056	0		29	10	S5810_056_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	057	0		29	10	S5810_057_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	058	0		29	10	S5810_058_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	059	0		29	10	S5810_059_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	060	0		29	10	S5810_060_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	061	0		29	10	S5810_061_0	2	4A7	1	2	110101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	062	0		29	10	S5810_062_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	063	0		29	10	S5810_063_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	064	0		29	10	S5810_064_0	2	4A7	1	2	110101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	065	0		29	10	S5810_065_0	2	4A7	1	2	110101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	066	0		29	10	S5810_066_0	3	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	067	0		29	10	S5810_067_0	2	4A7	1	2	101101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	068	0		29	10	S5810_068_0	2	4A7	1	2	110101	1	1	2		1	1	1	2			5	3				1	9																	3	2	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S5810	172	0		29	10	S5810_172_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	174	0		29	10	S5810_174_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	175	0		29	10	S5810_175_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	176	0		29	10	S5810_176_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	177	0		29	10	S5810_177_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	178	0		29	10	S5810_178_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	179	0		29	10	S5810_179_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	180	0		29	10	S5810_180_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	182	0		29	10	S5810_182_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	183	0		29	10	S5810_183_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	184	0		29	10	S5810_184_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	185	0		29	10	S5810_185_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	186	0		29	10	S5810_186_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	187	0		29	10	S5810_187_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	188	0		29	10	S5810_188_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	189	0		29	10	S5810_189_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	190	0		29	10	S5810_190_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	191	0		29	10	S5810_191_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	192	0		29	10	S5810_192_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	193	0		29	10	S5810_193_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	194	0		29	10	S5810_194_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	195	0		29	10	S5810_195_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	197	0		29	10	S5810_197_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	198	0		29	10	S5810_198_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	199	0		29	10	S5810_199_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	200	0		29	10	S5810_200_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	201	0		29	10	S5810_201_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	202	0		29	10	S5810_202_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	204	0		29	10	S5810_204_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	239	0		29	10	S5810_239_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	240	0		29	10	S5810_240_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	241	0		29	10	S5810_241_0	2	4A7	1	4	110101	1	1	2	2	1	1	1	2			5	3				1	9																			Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs		3								3	1	0100	2			1	3							1		000001	2																								
S5810	801	0		29	10	S5810_801_0	1		1																																																																																									
S5810	804	0		29	10	S5810_804_0	1		1																																																																																									
S5810	805	0		29	10	S5810_805_0	1		1																																																																																									
S5820	001	0		29	10	S5820_001_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	002	0		29	10	S5820_002_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	003	0		29	10	S5820_003_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	004	0		29	10	S5820_004_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	005	0		29	10	S5820_005_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	006	0		29	10	S5820_006_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	007	0		29	10	S5820_007_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	008	0		29	10	S5820_008_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	009	0		29	10	S5820_009_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	010	0		29	10	S5820_010_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	011	0		29	10	S5820_011_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	012	0		29	10	S5820_012_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	013	0		29	10	S5820_013_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	014	0		29	10	S5820_014_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	015	0		29	10	S5820_015_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	016	0		29	10	S5820_016_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	017	0		29	10	S5820_017_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	018	0		29	10	S5820_018_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	019	0		29	10	S5820_019_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	020	0		29	10	S5820_020_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	021	0		29	10	S5820_021_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	022	0		29	10	S5820_022_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	023	0		29	10	S5820_023_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	024	0		29	10	S5820_024_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	025	0		29	10	S5820_025_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	026	0		29	10	S5820_026_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	027	0		29	10	S5820_027_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	028	0		29	10	S5820_028_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	029	0		29	10	S5820_029_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	030	0		29	10	S5820_030_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	031	0		29	10	S5820_031_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	032	0		29	10	S5820_032_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	033	0		29	10	S5820_033_0	3	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5820	034	0		29	10	S5820_034_0	4	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5820	035	0		29	10	S5820_035_0	4	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5820	036	0		29	10	S5820_036_0	4	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5820	037	0		29	10	S5820_037_0	4	5A	1	3	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5820	038	0		29	10	S5820_038_0	4	5A	1	3	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5820	803	0		29	10	S5820_803_0	1		1																																																																																									
S5820	804	0		29	10	S5820_804_0	1		1																																																																																									
S5820	807	0		29	10	S5820_807_0	1		1																																																																																									
S5820	808	0		29	10	S5820_808_0	1		1																																																																																									
S5820	810	0		29	10	S5820_810_0	1		1																																																																																									
S5820	811	0		29	10	S5820_811_0	1		1																																																																																									
S5820	812	0		29	10	S5820_812_0	1		1																																																																																									
S5820	813	0		29	10	S5820_813_0	1		1																																																																																									
S5820	814	0		29	10	S5820_814_0	1		1																																																																																									
S5820	815	0		29	10	S5820_815_0	1		1																																																																																									
S5820	816	0		29	10	S5820_816_0	1		1																																																																																									
S5820	817	0		29	10	S5820_817_0	1		1																																																																																									
S5840	001	0		29	10	S5840_001_0	10		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		100			90					1	31	2
S5840	002	0		29	10	S5840_002_0	9	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S5840	801	0		29	10	S5840_801_0	8		1																																																																																									
S5840	802	0		29	10	S5840_802_0	8		1																																																																																									
S5857	802	0		29	10	S5857_802_0	3		1																																																																																									
S5857	803	0		29	10	S5857_803_0	3		1																																																																																									
S5877	004	0		29	10	S5877_004_0	3	4D	1	2	110110	1	1	2		1	1	1	2			4	4			4																			3	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier	1																																																		
S5877	007	0		29	10	S5877_007_0	3	4A	1	4	110110	1	1	2	2	1	1	1	2			4	4			1																					Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S5877	801	0		29	10	S5877_801_0	2		1																																																																																									
S5884	001	0		29	10	S5884_001_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	002	0		29	10	S5884_002_0	5	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	004	0		29	10	S5884_004_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	005	0		29	10	S5884_005_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	008	0		29	10	S5884_008_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	009	0		29	10	S5884_009_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	010	0		29	10	S5884_010_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	015	0		29	10	S5884_015_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	019	0		29	10	S5884_019_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	020	0		29	10	S5884_020_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	021	0		29	10	S5884_021_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	022	0		29	10	S5884_022_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	024	0		29	10	S5884_024_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	028	0		29	10	S5884_028_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	030	0		29	10	S5884_030_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	062	0		29	10	S5884_062_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	065	0		29	10	S5884_065_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	066	0		29	10	S5884_066_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	071	0		29	10	S5884_071_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	072	0		29	10	S5884_072_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	073	0		29	10	S5884_073_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	074	0		29	10	S5884_074_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	076	0		29	10	S5884_076_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	077	0		29	10	S5884_077_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	078	0		29	10	S5884_078_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	083	0		29	10	S5884_083_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	085	0		29	10	S5884_085_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	086	0		29	10	S5884_086_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	087	0		29	10	S5884_087_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	089	0		29	10	S5884_089_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	092	0		29	10	S5884_092_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	093	0		29	10	S5884_093_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	094	0		29	10	S5884_094_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		000110	2																								
S5884	101	0		29	10	S5884_101_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	102	0		29	10	S5884_102_0	5	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	103	0		29	10	S5884_103_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	104	0		29	10	S5884_104_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	105	0		29	10	S5884_105_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	106	0		29	10	S5884_106_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	107	0		29	10	S5884_107_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	108	0		29	10	S5884_108_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	109	0		29	10	S5884_109_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	110	0		29	10	S5884_110_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	111	0		29	10	S5884_111_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	112	0		29	10	S5884_112_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	113	0		29	10	S5884_113_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	114	0		29	10	S5884_114_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	115	0		29	10	S5884_115_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	116	0		29	10	S5884_116_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	131	0		29	10	S5884_131_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	132	0		29	10	S5884_132_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	133	0		29	10	S5884_133_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	134	0		29	10	S5884_134_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	135	0		29	10	S5884_135_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	136	0		29	10	S5884_136_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	137	0		29	10	S5884_137_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	138	0		29	10	S5884_138_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	139	0		29	10	S5884_139_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	140	0		29	10	S5884_140_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	141	0		29	10	S5884_141_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	142	0		29	10	S5884_142_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	143	0		29	10	S5884_143_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	144	0		29	10	S5884_144_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	145	0		29	10	S5884_145_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	146	0		29	10	S5884_146_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	147	0		29	10	S5884_147_0	4	5A	1	2	101101	1	1	1		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5884	148	0		29	10	S5884_148_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	149	0		29	10	S5884_149_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	150	0		29	10	S5884_150_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	151	0		29	10	S5884_151_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	152	0		29	10	S5884_152_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	153	0		29	10	S5884_153_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	154	0		29	10	S5884_154_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	155	0		29	10	S5884_155_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	156	0		29	10	S5884_156_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	157	0		29	10	S5884_157_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	158	0		29	10	S5884_158_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	159	0		29	10	S5884_159_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	160	0		29	10	S5884_160_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	161	0		29	10	S5884_161_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	162	0		29	10	S5884_162_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	163	0		29	10	S5884_163_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	164	0		29	10	S5884_164_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	165	0		29	10	S5884_165_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	166	0		29	10	S5884_166_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	167	0		29	10	S5884_167_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	168	0		29	10	S5884_168_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	169	0		29	10	S5884_169_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	170	0		29	10	S5884_170_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	171	0		29	10	S5884_171_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	172	0		29	10	S5884_172_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	173	0		29	10	S5884_173_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	174	0		29	10	S5884_174_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	175	0		29	10	S5884_175_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	176	0		29	10	S5884_176_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	177	0		29	10	S5884_177_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	178	0		29	10	S5884_178_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	179	0		29	10	S5884_179_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	180	0		29	10	S5884_180_0	3	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	011000	1				2	1	0010	2			2	3							1			2																								
S5884	834	0		29	10	S5884_834_0	1		1																																																																																									
S5884	835	0		29	10	S5884_835_0	1		1																																																																																									
S5884	836	0		29	10	S5884_836_0	1		1																																																																																									
S5904	001	0		29	10	S5904_001_0	8	5A	1	3	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1							3							1			2																								
S5904	002	0		29	10	S5904_002_0	5	5A	1	4	101110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		011001	2																								
S5904	801	0		29	10	S5904_801_0	1		1																																																																																									
S5904	802	0		29	10	S5904_802_0	1		1																																																																																									
S5907	001	0		29	10	S5907_001_0	10	5A	1	2	101110	1	1	2		1	1	1	1		1	5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5907	002	0		29	10	S5907_002_0	9	5A	1	4	101110	1	1	1	2	1	1	1	1		1	5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
S5907	801	0		29	10	S5907_801_0	6		1																																																																																									
S5907	802	0		29	10	S5907_802_0	6		1																																																																																									
S5916	001	0		29	10	S5916_001_0	4	5A	1	3	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		2	145.00	1						1							3							1			2																								
S5916	002	0		29	10	S5916_002_0	4	5A	1	4	110110	1	1	2	2	1	1	2	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			1	3							1		010000	2																								
S5916	802	0		29	10	S5916_802_0	2		1																																																																																									
S5921	003	0		29	10	S5921_003_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	013	0		29	10	S5921_013_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	023	0		29	10	S5921_023_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	033	0		29	10	S5921_033_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	043	0		29	10	S5921_043_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	053	0		29	10	S5921_053_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	063	0		29	10	S5921_063_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	073	0		29	10	S5921_073_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	083	0		29	10	S5921_083_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	093	0		29	10	S5921_093_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	103	0		29	10	S5921_103_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	113	0		29	10	S5921_113_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	123	0		29	10	S5921_123_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	133	0		29	10	S5921_133_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	143	0		29	10	S5921_143_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	153	0		29	10	S5921_153_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	163	0		29	10	S5921_163_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	173	0		29	10	S5921_173_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	183	0		29	10	S5921_183_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	193	0		29	10	S5921_193_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	213	0		29	10	S5921_213_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	223	0		29	10	S5921_223_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	233	0		29	10	S5921_233_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	235	0		29	10	S5921_235_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	239	0		29	10	S5921_239_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	249	0		29	10	S5921_249_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	263	0		29	10	S5921_263_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	273	0		29	10	S5921_273_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	293	0		29	10	S5921_293_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	303	0		29	10	S5921_303_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	323	0		29	10	S5921_323_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	333	0		29	10	S5921_333_0	4	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011111	2																								
S5921	348	0		29	10	S5921_348_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	349	0		29	10	S5921_349_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	350	0		29	10	S5921_350_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	351	0		29	10	S5921_351_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	352	0		29	10	S5921_352_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	353	0		29	10	S5921_353_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	354	0		29	10	S5921_354_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	355	0		29	10	S5921_355_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	356	0		29	10	S5921_356_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	357	0		29	10	S5921_357_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	358	0		29	10	S5921_358_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	359	0		29	10	S5921_359_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	360	0		29	10	S5921_360_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	361	0		29	10	S5921_361_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	362	0		29	10	S5921_362_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	363	0		29	10	S5921_363_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	364	0		29	10	S5921_364_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	365	0		29	10	S5921_365_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	366	0		29	10	S5921_366_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	367	0		29	10	S5921_367_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	368	0		29	10	S5921_368_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	369	0		29	10	S5921_369_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	370	0		29	10	S5921_370_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	371	0		29	10	S5921_371_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	372	0		29	10	S5921_372_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	373	0		29	10	S5921_373_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	374	0		29	10	S5921_374_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	375	0		29	10	S5921_375_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	376	0		29	10	S5921_376_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	377	0		29	10	S5921_377_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	378	0		29	10	S5921_378_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	379	0		29	10	S5921_379_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	380	0		29	10	S5921_380_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	381	0		29	10	S5921_381_0	3	5A	1	2	101101	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5921	802	0		29	10	S5921_802_0	1		1																																																																																									
S5921	837	0		29	10	S5921_837_0	1		1																																																																																									
S5932	001	0		29	10	S5932_001_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	002	0		29	10	S5932_002_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	003	0		29	10	S5932_003_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	004	0		29	10	S5932_004_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	005	0		29	10	S5932_005_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	006	0		29	10	S5932_006_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	007	0		29	10	S5932_007_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	008	0		29	10	S5932_008_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	009	0		29	10	S5932_009_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	010	0		29	10	S5932_010_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	011	0		29	10	S5932_011_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	012	0		29	10	S5932_012_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	013	0		29	10	S5932_013_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	014	0		29	10	S5932_014_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	015	0		29	10	S5932_015_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	016	0		29	10	S5932_016_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	017	0		29	10	S5932_017_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	018	0		29	10	S5932_018_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	019	0		29	10	S5932_019_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	020	0		29	10	S5932_020_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	021	0		29	10	S5932_021_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	022	0		29	10	S5932_022_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	023	0		29	10	S5932_023_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	024	0		29	10	S5932_024_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	025	0		29	10	S5932_025_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	026	0		29	10	S5932_026_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	027	0		29	10	S5932_027_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	028	0		29	10	S5932_028_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	029	0		29	10	S5932_029_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	030	0		29	10	S5932_030_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	031	0		29	10	S5932_031_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	032	0		29	10	S5932_032_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	033	0		29	10	S5932_033_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	034	0		29	10	S5932_034_0	1		1	1	110110	1	1	2		1	1	1	2																																																										111	30	60	90					01	30		110	30		90					1	31	2
S5932	802	0		29	10	S5932_802_0	1		1																																																																																									
S5932	803	0		29	10	S5932_803_0	1		1																																																																																									
S5953	001	0		29	10	S5953_001_0	5	5A	1	3	110101	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5953	002	0		29	10	S5953_002_0	5	5A	1	4	110101	1	1	2	2	1	1	1	2			5	5				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
S5953	801	0		29	10	S5953_801_0	2		1																																																																																									
S5953	802	0		29	10	S5953_802_0	2		1																																																																																									
S5960	108	0		29	10	S5960_108_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	109	0		29	10	S5960_109_0	2	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	110	0		29	10	S5960_110_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	111	0		29	10	S5960_111_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	112	0		29	10	S5960_112_0	4	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	114	0		29	10	S5960_114_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	115	0		29	10	S5960_115_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	117	0		29	10	S5960_117_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	118	0		29	10	S5960_118_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	119	0		29	10	S5960_119_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	123	0		29	10	S5960_123_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	125	0		29	10	S5960_125_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	126	0		29	10	S5960_126_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	127	0		29	10	S5960_127_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	128	0		29	10	S5960_128_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	129	0		29	10	S5960_129_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	130	0		29	10	S5960_130_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	131	0		29	10	S5960_131_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	132	0		29	10	S5960_132_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	134	0		29	10	S5960_134_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	136	0		29	10	S5960_136_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	137	0		29	10	S5960_137_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	139	0		29	10	S5960_139_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	140	0		29	10	S5960_140_0	3	5B8	1	3	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		1		2	010000	1				2							3							1			2																								
S5960	147	0		29	10	S5960_147_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5960	157	0		29	10	S5960_157_0	4	5B8	1	4	101110	1	1	2	2	1	1	1	2			6	4											2		3											Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier		3								2	1	0100	2			1	3							1		010000	2																								
S5960	801	0		29	10	S5960_801_0	2		1																																																																																									
S5960	803	0		29	10	S5960_803_0	2		1																																																																																									
S5966	001	0		29	10	S5966_001_0	4	4D	1	2	110110	1	1	2		1	1	1	2			4	3			4																			2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier	1																																																		
S5966	803	0		29	10	S5966_803_0	2		1																																																																																									
S5967	138	0		29	10	S5967_138_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	139	0		29	10	S5967_139_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	140	0		29	10	S5967_140_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	141	0		29	10	S5967_141_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	142	0		29	10	S5967_142_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	143	0		29	10	S5967_143_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	144	0		29	10	S5967_144_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	145	0		29	10	S5967_145_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	146	0		29	10	S5967_146_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	147	0		29	10	S5967_147_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	148	0		29	10	S5967_148_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	149	0		29	10	S5967_149_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	150	0		29	10	S5967_150_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	151	0		29	10	S5967_151_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	152	0		29	10	S5967_152_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	154	0		29	10	S5967_154_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	155	0		29	10	S5967_155_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	156	0		29	10	S5967_156_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	157	0		29	10	S5967_157_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	158	0		29	10	S5967_158_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	159	0		29	10	S5967_159_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	160	0		29	10	S5967_160_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	161	0		29	10	S5967_161_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	162	0		29	10	S5967_162_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	163	0		29	10	S5967_163_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	164	0		29	10	S5967_164_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	165	0		29	10	S5967_165_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	166	0		29	10	S5967_166_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	167	0		29	10	S5967_167_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	168	0		29	10	S5967_168_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	169	0		29	10	S5967_169_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	170	0		29	10	S5967_170_0	4	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	171	0		29	10	S5967_171_0	5	5A	1	3	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2							3							1			2																								
S5967	173	0		29	10	S5967_173_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	174	0		29	10	S5967_174_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	175	0		29	10	S5967_175_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	176	0		29	10	S5967_176_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	177	0		29	10	S5967_177_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	178	0		29	10	S5967_178_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	179	0		29	10	S5967_179_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	180	0		29	10	S5967_180_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	181	0		29	10	S5967_181_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	182	0		29	10	S5967_182_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	183	0		29	10	S5967_183_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	184	0		29	10	S5967_184_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	185	0		29	10	S5967_185_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	186	0		29	10	S5967_186_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	187	0		29	10	S5967_187_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	188	0		29	10	S5967_188_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	189	0		29	10	S5967_189_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	190	0		29	10	S5967_190_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	191	0		29	10	S5967_191_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	192	0		29	10	S5967_192_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	193	0		29	10	S5967_193_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	194	0		29	10	S5967_194_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	195	0		29	10	S5967_195_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	196	0		29	10	S5967_196_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	197	0		29	10	S5967_197_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	198	0		29	10	S5967_198_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	199	0		29	10	S5967_199_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	200	0		29	10	S5967_200_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	201	0		29	10	S5967_201_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	202	0		29	10	S5967_202_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	203	0		29	10	S5967_203_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	204	0		29	10	S5967_204_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	205	0		29	10	S5967_205_0	4	5A	1	4	101101	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			2	3							1			2																								
S5967	803	0		29	10	S5967_803_0	1		1																																																																																									
S5967	804	0		29	10	S5967_804_0	1		1																																																																																									
S5975	801	0		29	10	S5975_801_0	1		1																																																																																									
S5975	805	0		29	10	S5975_805_0	1		1																																																																																									
S5983	004	0		29	10	S5983_004_0	2	5A	1	2	110101	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5983	006	0		29	10	S5983_006_0	2	5A	1	4	101101	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0110	2			2	3							1			2																								
S5983	801	0		29	10	S5983_801_0	1		1																																																																																									
S5983	802	0		29	10	S5983_802_0	1		1																																																																																									
S5983	803	0		29	10	S5983_803_0	1		1																																																																																									
S5983	804	0		29	10	S5983_804_0	1		1																																																																																									
S5993	001	0		29	10	S5993_001_0	5	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S5993	003	0		29	10	S5993_003_0	6	5A	1	4	110110	1	1	2	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0110	2			1	3							1		011000	2																								
S5993	801	0		29	10	S5993_801_0	3		1																																																																																									
S6506	001	0		29	10	S6506_001_0	4	4C	1	2	101101	1	1	2		1	1	1	2			4	4			3																			2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand	1																																																		
S6506	002	0		29	10	S6506_002_0	4	4C	1	4	110110	1	1	2	2	1	1	1	2			4	4			3																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand		3								2	1	0110	2			2	3							1			2																								
S6506	801	0		29	10	S6506_801_0	1		1																																																																																									
S6875	801	0		29	10	S6875_801_0	1		1																																																																																									
S6875	802	0		29	10	S6875_802_0	1		1																																																																																									
S7230	001	0		29	10	S7230_001_0	1	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S7230	002	0		29	10	S7230_002_0	1	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S7230	003	0		29	10	S7230_003_0	1	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S7610	001	0		29	10	S7610_001_0	1	5A	1	2	110110	1	1	2		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S7694	001	0		29	10	S7694_001_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	002	0		29	10	S7694_002_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	003	0		29	10	S7694_003_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	004	0		29	10	S7694_004_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	005	0		29	10	S7694_005_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	006	0		29	10	S7694_006_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	007	0		29	10	S7694_007_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	008	0		29	10	S7694_008_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	009	0		29	10	S7694_009_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	010	0		29	10	S7694_010_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	011	0		29	10	S7694_011_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	012	0		29	10	S7694_012_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	014	0		29	10	S7694_014_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	015	0		29	10	S7694_015_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	016	0		29	10	S7694_016_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	017	0		29	10	S7694_017_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	018	0		29	10	S7694_018_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	019	0		29	10	S7694_019_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	020	0		29	10	S7694_020_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	021	0		29	10	S7694_021_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	022	0		29	10	S7694_022_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	023	0		29	10	S7694_023_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	024	0		29	10	S7694_024_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	025	0		29	10	S7694_025_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	026	0		29	10	S7694_026_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	027	0		29	10	S7694_027_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	028	0		29	10	S7694_028_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	029	0		29	10	S7694_029_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	030	0		29	10	S7694_030_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	031	0		29	10	S7694_031_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	032	0		29	10	S7694_032_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	033	0		29	10	S7694_033_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	034	0		29	10	S7694_034_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	070	0		29	10	S7694_070_0	2	5A7	1	2	110110	1	1	2		1	1	1	2			6	4											1	9										2	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs	1																																																		
S7694	801	0		29	10	S7694_801_0	1		1																																																																																									
S7694	802	0		29	10	S7694_802_0	1		1																																																																																									
S7950	801	0		29	10	S7950_801_0	1		1																																																																																									
S7950	802	0		29	10	S7950_802_0	2		1																																																																																									
S7950	803	0		29	10	S7950_803_0	1		1																																																																																									
S7950	804	0		29	10	S7950_804_0	1		1																																																																																									
S7950	805	0		29	10	S7950_805_0	1		1																																																																																									
S7950	806	0		29	10	S7950_806_0	1		1																																																																																									
S7950	807	0		29	10	S7950_807_0	1		1																																																																																									
S8067	001	0		29	10	S8067_001_0	5	4D	1	3	101110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								2							3							1			2																								
S8067	003	0		29	10	S8067_003_0	4	5A	1	4	101110	1	1	2	2	1	1	1	2			5	3				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								2	1	0100	2			2	3							1			2																								
S8067	801	0		29	10	S8067_801_0	3		1																																																																																									
S8067	802	0		29	10	S8067_802_0	3		1																																																																																									
S8841	803	0		29	10	S8841_803_0	4		1																																																																																									
S8841	804	0		29	10	S8841_804_0	4		1																																																																																									
S8841	807	0		29	10	S8841_807_0	2		1																																																																																									
S8841	808	0		29	10	S8841_808_0	2		1																																																																																									
S8841	810	0		29	10	S8841_810_0	2		1																																																																																									
S9014	001	0		29	10	S9014_001_0	2		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
S9014	002	0		29	10	S9014_002_0	2	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S9014	003	0		29	10	S9014_003_0	2		1	1	110110	1	1	2		1	1	1	2																																																										110	30		90					01	30		110	30		90					1	31	2
S9014	004	0		29	10	S9014_004_0	2	4D	1	4	110110	1	1	2	2	1	1	1	2			4	3			4																					Preferred Generic, Non-Preferred Generic, Preferred Brand, Specialty Tier		3								1	1	0110	2			1	3							1		011000	2																								
S9014	801	0		29	10	S9014_801_0	2		1																																																																																									
S9579	001	0		29	10	S9579_001_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	002	0		29	10	S9579_002_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	003	0		29	10	S9579_003_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	004	0		29	10	S9579_004_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	005	0		29	10	S9579_005_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	006	0		29	10	S9579_006_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	007	0		29	10	S9579_007_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	008	0		29	10	S9579_008_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	009	0		29	10	S9579_009_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	010	0		29	10	S9579_010_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	011	0		29	10	S9579_011_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	012	0		29	10	S9579_012_0	4	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	013	0		29	10	S9579_013_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	014	0		29	10	S9579_014_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	015	0		29	10	S9579_015_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	016	0		29	10	S9579_016_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	017	0		29	10	S9579_017_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	018	0		29	10	S9579_018_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	019	0		29	10	S9579_019_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	020	0		29	10	S9579_020_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	021	0		29	10	S9579_021_0	4	5A	1	2	101110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	022	0		29	10	S9579_022_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	023	0		29	10	S9579_023_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	024	0		29	10	S9579_024_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	025	0		29	10	S9579_025_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	026	0		29	10	S9579_026_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	027	0		29	10	S9579_027_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	028	0		29	10	S9579_028_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	029	0		29	10	S9579_029_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	030	0		29	10	S9579_030_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	031	0		29	10	S9579_031_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	032	0		29	10	S9579_032_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	033	0		29	10	S9579_033_0	4	5A	1	2	110110	1	1	1		1	1	1	2			5	4				7																		1	2	Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier	1																																																		
S9579	034	0		29	10	S9579_034_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	035	0		29	10	S9579_035_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	036	0		29	10	S9579_036_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	037	0		29	10	S9579_037_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	038	0		29	10	S9579_038_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	039	0		29	10	S9579_039_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	040	0		29	10	S9579_040_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	041	0		29	10	S9579_041_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	042	0		29	10	S9579_042_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	043	0		29	10	S9579_043_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	044	0		29	10	S9579_044_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	045	0		29	10	S9579_045_0	5	5A	1	4	101110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	046	0		29	10	S9579_046_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	047	0		29	10	S9579_047_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	048	0		29	10	S9579_048_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	049	0		29	10	S9579_049_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	050	0		29	10	S9579_050_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	051	0		29	10	S9579_051_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	052	0		29	10	S9579_052_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	053	0		29	10	S9579_053_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	054	0		29	10	S9579_054_0	5	5A	1	4	101110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	055	0		29	10	S9579_055_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	056	0		29	10	S9579_056_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	057	0		29	10	S9579_057_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	058	0		29	10	S9579_058_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	059	0		29	10	S9579_059_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	060	0		29	10	S9579_060_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	061	0		29	10	S9579_061_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	062	0		29	10	S9579_062_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	063	0		29	10	S9579_063_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	064	0		29	10	S9579_064_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	065	0		29	10	S9579_065_0	5	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	066	0		29	10	S9579_066_0	4	5A	1	4	110110	1	1	1	2	1	1	1	2			5	4				7																				Preferred Generic, Non-Preferred Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier		3								1	1	0100	2			2	3							1			2																								
S9579	803	0		29	10	S9579_803_0	1		1																																																																																									
S9579	804	0		29	10	S9579_804_0	1		1																																																																																									
